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The state of healthcare insurance, medical debt


About 10 percent of adult Americans remain uninsured.

The state of healthcare insurance, medical debt

After a year in which Americans were battered by the COVID-19 pandemic, many remain uninsured and even more have had problems paying medical bills.

According to findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, which was fielded from March to June and included responses from 5,450 adults, about 10 percent of adult Americans were uninsured in the first half of the year. These rates were higher among Latinx/Hispanic (20 percent) and Black (11 percent) respondents.

Nearly half of the respondents say they had been directly affected by the pandemic by either catching COVID-19, losing income, or losing employer coverage. A further six percent of working-age respondents say they lost their employer health insurance because of job loss tied to the COVID-19 pandemic. Of these respondents, 67 percent reported they gained other health coverage, the survey says.

About 38 percent of respondents reported having a medical bill problem or were paying off medical debts. Among uninsured respondents, 50 percent reported having a bill problem or medical debts, compared to 36 percent of insured respondents. Those respondents directly affected by the pandemic reported problems with billing and medical debt at higher rates than those not directly affected by COVID-19, according to the survey.

Of those respondents with medical bill and debt problems, 35 percent say they’ve used up all or most of their savings, 35 percent took on credit card debt, 27 percent were unable to pay for basic necessities, and 23 percent delayed education or their career plans, the survey says.

The survey authors give recommendations on how to make health insurance more available and more comprehensive. These include:

  • Make the temporary American Rescue Plan marketplace subsidies permanent to potentially reduce the number of uninsured by 4.2 million in 2022.
  • Provide Medicaid-eligible adults in the 13 states that have not yet expanded their program a federal insurance option to cover an estimated 2.3 million uninsured people.
  • Rein in deductibles and out-of-pocket costs in marketplace plans. A bill introduced by Senator Jeanne Shaheen (D–N.H.) could eliminate deductibles for some people and reduce it for others by as much as $1,650.
  • Standardize and simplify health plans sold in the marketplaces to make it easier for consumers to understand which health services are covered.

The full survey results can be found here.

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