The research was based on a nationally representative telephone survey in 2010. Surveys conducted in 2010, after the Great Recession drove unemployment upward, and 2007, prior to the economic downturn, found little change in households struggling with medical debt.
With financial distress came other troubles, including collection agencies and borrowing to pay off medical bills, the research found. Some withdrew savings. Others struggled to pay for necessities.
Cunningham said those with medical bills were also more likely to put off medical care out of concern for the cost.
Like Cunningham, Patricia Herman, a research scientist at the Center for Health Outcomes and PharmacoEconomics Research at the University of Arizona College of Pharmacy, said she did not find the CDC results surprising. Herman and colleagues studied 2008 survey data on insurance coverage and medical debt in Arizona and found insured households were as likely as the uninsured to struggle with medical bills. Herman praised the CDC report for highlighting an issue she described as “almost a secret.”
“It's amazing to me that it's so prevalent and devastating” but so little studied, Herman said.
Indeed, the Arizona research found medical debt mattered more than whether someone was insured when it came to who would be most likely to delay or skip needed medical care, Herman said. Early results of subsequent research suggest health plans with co-insurance leave households particularly vulnerable to medical debt, she said. Households can plan for co-payments and deductibles, but the cost from co-insurance can depend on the medical care needed when someone unexpectedly becomes ill or injured.
Dr. David Himmelstein, a professor of public health at the City University of New York, said the fault lies not only with the out-of-pocket fees such as deductibles but coverage and reimbursement limits that also shift more cost to households.
Himmelstein is an advocate for a single-payer health system and co-founder of Physicians for a National Health Program, and he co-authored a 2009 study that found medical debt contributed to 62% of U.S. bankruptcies. In an earlier study, Himmelstein and colleagues surveyed more than 1,700 bankruptcy filers and found among those for whom medical bills were a significant factor, 75% were covered by insurance when they fell ill.