Half of working-age Americans struggle to pay for healthcare and one in three owes money to a hospital, doctor or other healthcare provider, a new survey shows.

The survey by The Commonwealth Fund, a private foundation that focuses on equitable access to healthcare, also reports that nearly two in five people skipped or delayed needed medical care or didn’t fill a prescription in the past year because they couldn’t afford the bills. The survey revealed that even people who get health insurance through the workplace or elsewhere often can’t afford health costs.

The financial strain of paying for rising healthcare costs has made Americans sicker and often put them in debt, said Sara Collins, a senior scholar and vice president at the New York-based foundation.

“The findings challenge the assumption that health insurance in the U.S. buys everyone affordable access to care,” Collins said.

Even with insurance, millions struggle to pay for health care

Nearly three in four people without health insurance struggled to pay for healthcare, but even people with coverage had difficulty paying for health care.

Nearly 6 in 10 people who bought their own health insurance through the Affordable Care Act marketplace, brokers or other health insurance sellers said it was “very or somewhat difficult” to afford healthcare costs. People who got insurance through Medicare, Medicaid or the workplace also reported financial struggles.

According to the telephone and online survey of a random sample of more than 7,800 adults conducted April 18 through July 31:

∎ 38% of people surveyed delayed or skipped needed healthcare or filling a prescription drug because they could not afford the cost.

∎ More than half of adults who skipped care said that a health problem worsened as a result.

1 in 3 adults owed money to a doctor, dentist, other medical provider

Medical bills are straining Americans’ pocketbooks with one-third of adults reporting they owed money to a doctor, dentist, hospital, home health worker, nursing home or other provider. Those bills stemmed from routine care for chronic health conditions nearly as often as they did from emergencies or recently diagnosed health problems.

Among those who owed a medical debt, the survey said nearly half owed $2,000 or more. Nearly two-thirds of adults who owed money for a medical bill paid their health care provider directly, but past-due bills for about one-third of adults were turned over to collection agencies.

In 2021, consumers owed about $88 billion in medical debt, making it the largest category of consumer debt. When consumers owe medical debt, it’s often turned over to collection agencies and appears on consumer credit reports which can make it difficult for people to buy a house or finance a car.

The Biden administration has proposed federal rules barring unpaid medical debt from appearing on consumers’ credit reports.

An overwhelming number of survey respondents said medical debt made people anxious or worried. But consumers also had to make other sacrifices to pay their medical bills:

∎ 39% cut back on necessities like food, heat or rent;

∎ 37% spent all or part of their savings on medical debt;

∎ 25% took another job or worked more hours at an existing job.

Joseph Betancourt, a primary care doctor and president of The Commonwealth Fund, said he sees daily examples of patients struggling to afford health care. Patients are confused and frustrated and “face legitimate threats to their health and well-being.”

“These affordability challenges are real,” Betancourt said. “They’re getting worse, and they’re a clear and present danger to people’s health and well-being.”

Ken Alltucker is on X, formerly Twitter, at @kalltucker, or can be emailed at [email protected]