Story at a glance
- In 2019, 45.5 million Americans were in families that struggled to pay their medical bills.
- New data show that by 2021, that total fell to 35 million.
- Policies enacted during the COVID-19 pandemic may have contributed to the decline.
The number of Americans in families who struggled to pay medical bills decreased from 14 percent in 2019 to 10.8 percent in 2021, Centers for Disease Control and Prevention (CDC) data show. That amounts to 10.5 million fewer people struggling to pay the bills in 2021.
Findings are based on National Health Interview Surveys carried out in 2019, 2020 and 2021, which measured individuals’ ability to pay medical bills within the last 12 months.
The decrease could be due in part to policies implemented throughout the COVID-19 pandemic like the American Rescue Plan Act of 2021. Provisions in the law allowed Americans more flexibility with payments to creditors, unemployment assistance and improvements in paid sick leave.
COBRA premium subsidies and changes to Medicaid under the Act may have also boosted the percentage of Americans covered by insurance, another factor that could have helped Americans pay for medical care.
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Many Americans also skipped preventive and elective health care appointments and hospital emergency department visits in the early phases of the pandemic, for fear of catching COVID-19. This dropoff in health care utilization could have contributed to the decrease in struggles reported.
Medical debt is a leading form of debt in the United States, with rates higher in the South and in lower-income communities.
According to the latest CDC data, low family income, being uninsured or living in a state that has not expanded Medicaid were all linked with challenges paying medical bills.
Those who have problems paying medical bills may face additional financial hardships when it comes to paying for food, clothing or housing, while adults with medical debt are more likely to forgo care due to cost, report authors explained.
The National Health Interview Surveys revealed the percentage of people in families having problems paying medical bills was higher among children and adults between the ages 18 and 64, compared with adults aged 65 and older.
Among older adults, those with private coverage were less likely than those with Medicare and Medicaid, Medicare Advantage and traditional Medicare to report problems.
Men were also less likely than women to have problems paying medical bills in 2021, and Black Americans were more likely to report struggles than Hispanic, white and Asian individuals.
“Despite the decreasing trend in the percentage of people with problems paying medical bills, the burden associated with unpaid medical bills remains a public health concern,” report authors concluded.
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