Having health insurance doesn’t guarantee being able to afford healthcare costs, according to a new report from the Commonwealth Fund.

Among working-age American adults surveyed, 43% with employer coverage and 57% with marketplace or individual market plans said it was somewhat difficult or very difficult to afford their healthcare. Across all insurance types, 51% of those surveyed reported difficulty affording healthcare.

Dr. Joseph Betancourt, president of the Commonwealth Fund and a practicing physician, explained that he sees these challenges regarding healthcare affordability from patients “almost every day.”

“What patients experience ranges from confusion to frustration to legitimate threats to their health and well-being,” Betancourt said. “This includes the patient that chooses not to go to the emergency room when they have chest pain because they’re afraid they can’t afford their copay, which recently tripled from the year before. Or the patient that goes to get a time-sensitive CT scan only to find out upon arrival at the imaging center that there’s an out-of-network copay they didn't know about and can’t afford, leading them to abandon the effort.”

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This is indicated in the Commonwealth Fund findings — 29% of those with employer coverage and 37% with marketplace or individual market plans stated that they or a family member had either delayed or skipped needed healthcare or prescription drugs in the last 12 months because they couldn’t afford it.

These cost-driven delays are also making people sicker. The survey found that “54% of people with employer coverage who reported delaying or forgoing care because of costs said a health problem of theirs or a family member got worse because of it, as did 61% in marketplace or individual-market plans, 60% with Medicaid, and 63% with Medicare.”

“One thing is for sure: Patients are impacted by this every day,” Betancourt said. “These affordability challenges are real. They’re getting worse and there are clear and present dangers to people’s health and well-being. And like many challenges in healthcare, those who are most vulnerable are at greatest risk.”

'Deleterious effects' on health

Lower- and middle-income individuals and families are disproportionately impacted by healthcare affordability, particularly in the current inflationary environment in the US.

According to the Consumer Price Index for September 2023, medical care commodities, which include prescription drugs and medical equipment and supplies, decreased by 2.6% on a year-over-year basis. However, medical care services, which include professional services, hospital and related services, and health insurance, rose by 4.2%.