Fewer patients struggle with medical debt

An improving economy, less expensive preventive care and reduced use of health services all appear to be contributing to fewer people reporting trouble paying their medical bills.

A Centers for Disease Control and Prevention report released in June looked at medical debt from June 2011 to June 2012 (link). It found that the percentage of people younger than 65 in families having problems paying medical bills dropped from 21.7% to 20.3% over that period.

The survey asked respondents, “In the past 12 months, did you/anyone in the family have problems paying or were unable to pay any medical bills?” That included bills for doctors, hospitals, therapists, medication, equipment, nursing homes or home care.

The percentage of men saying they were having issues with medical debt dropped from 20.8% to 19.7%, while women dropped from 22.6% to 20.8%, according to the CDC report, which surveyed about 155,000 people.

The report also indicated that people who said they had trouble with medical debt decreased across major age groups. Children ages 0 to 17 in families having trouble paying their bills dropped from 23.7% to 21.8%, and for ages 18 to 64, those in families having debt issues went from 20.9% to 19.7%.

It was also true for the poor, defined as below the U.S. Census Bureau poverty threshold . The percentage of people in that group who had trouble paying medical bills dropped from 32.8% to 30.3%.

But the percentage of uninsured with medical debt issues increased over that period, from 35.7% to 36.3%, according to the report. Those with private insurance who said they had trouble paying medical bills dropped from 15.7% to 14.0%, and those with public insurance declined from 28.0% to 25.6%.

What’s behind the decline

The CDC survey is the most extensive of numerous reports that have found fewer patients reporting no trouble with — or at least no increase in — medical debt, or feeling like cost is less a barrier to care than it once had been.

It’s possible that one factor behind the CDC’s reported decline in medical debt issues is that some are avoiding doctors and hospitals, if they can, to avoid running up debt in the first place, said Shana Alex Lavarreda, PhD, director of health insurance studies at the UCLA Center for Health Policy Research.

However, other reasons for the decline are more positive. An improving economy may be adding to insured enrollees’ ability to pay their bills when they are incurred, she said. Meanwhile, expansion of coverage under the Affordable Care Act also is having an effect, she said.

Many provisions of the ACA aren’t fully in place until 2014, but provisions such as allowing children 26 or younger to stay on their parents’ health plans and a requirement that insurers charge no out-of-pocket costs for certain preventive procedures have been cited in other studies looking at Americans’ increasing ability to pay for health care.

“The Affordable Care Act has made preventive services available to nearly everyone at no charge,” Lavarreda wrote in an e-mail. “This would reduce the debt incurred for tests like colonoscopies, which, prior to the ACA, could potentially cost thousands of dollars depending on the complication that might arise during the procedure.”

Most medical debt is less than $4,000, based on data from the California Health Interview Survey, the nation’s largest state health survey, Lavarreda wrote.