The high cost of health care can be a barrier to access for both insured people (particularly those with high deductibles) and the uninsured. Today, a report from the National Center for Health Statistics finds that the share of adults reporting difficulty paying medical bills has declined in recent years. Similarly, a recent Commonwealth Fund survey of adults in the U.S. and 10 other countries found that fewer Americans report cost-related access barriers than did in 2013, though Americans still have more difficulty accessing care due to cost reasons than people living in the 10 other countries, on average.
In this post and corresponding chart collection, we analyze data from the U.S. CDC’s National Health Interview Survey to examine trends in Americans’ access to health care from 1998 through 2015. In 2015, nearly one in 10 adults (9%) reported delaying or not receiving medical care due to cost. We find that in 2015, rates of cost-related access barriers were lower than in any other year during this period for low-income people (11%, down from a recent high of 17% in the early years of the recent economic downturn and a low of 12% in 2002).
Similarly, rates of cost-related access barriers are at their lowest in 2015 for those in worse health (18%, down from a recent high of 26% in 2009, and a low of 19% in 1998). Before the recent economic downturn, about 22% of adults in worse health reported cost-related access barriers to care. After peaking at 26% in 2009, the rate of cost-related access barriers for those in worse health returned to pre-recession rates by 2013, and then continued to decline to 18% in 2015 – the lowest rate since at least 1998.
Dental care (11%), prescription drugs (6%), and eye glasses (6%) top of the list of the types of care which were delayed or forgone because of cost in 2015. The vast majority of American adults are in good or excellent health (88%) and/or have medical insurance (89%), and are thus less likely to encounter cost-related access barriers. Adults in worse health, those with low incomes, and the uninsured are much more likely than others to delay or forgo health services due to costs:
- Nearly one in five adults (18%) who reported being in worse health said they delayed or did not receive medical care due to cost barriers, while 7% of respondents in better health reported the same.
- Without medical insurance, cost-related access problems are more common for Americans. Unaffordable medical costs caused more than 1 in 4 uninsured adults (28%) to delay or go without health care in 2015. Meanwhile, 7% of adults who have health insurance reported encountering cost-related access barriers to care.
- Lower income adults on average report more cost-related barriers to accessing medical care (11%) than higher income adults (5%). As mentioned above, 11% is the lowest rate of reported access barriers among this group since at least 1998.
Between 2011 and 2013 (the year before the major coverage expansions of the Affordable Care Act went into effect), the share of adults in worse health reporting worry about their ability to pay for medical care increased from 59% to 61%. After the coverage expansions went into effect, the share dropped to 56% in 2014, and then 53% in 2015.
The uninsured rate in the U.S. has fallen to an all-time low as a result of the Affordable Care Act. Still, about 28.9 million people remained uninsured in 2015. (A recent Kaiser Family Foundation analysis found that 43% of the remaining uninsured could qualify for assistance to purchase health insurance or enroll in Medicaid, but for one reason or another have not taken advantage of this assistance.) From our analysis of NHIS data, we find that half of uninsured adults (50%) report having no usual source of care, while 10% of those with insurance say the same. Similarly, of uninsured adults who did not report having a usual source of care, the majority (70%) also said they went without preventive health care services.
Following the recent election, the future of the Affordable Care Act is uncertain. One of the main objectives of the recent health care reform legislation was to increase access to care through increased affordability. In the years since its initial implementation, survey data from a variety of sources suggest that rates of cost-related access barriers have fallen, particularly for lower-income people and those in worse health , but access remains a challenge for many Americans in the early years of the health reform law.