– According to a report by the Robert Wood Johnson Foundation, policies around the coronavirus pandemic may have helped curb unmet care, inaccessibility of care and some care inequalities, but these trends may also reflect lower overall use of care a due to healthcare disruptions during the pandemic.
The researchers used the Urban Institute’s annual Basic Needs and Well-Being Survey (WBNS) from 2017 to 2022, with approximately 7,500 KnowledgePanel participants aged 18 to 64 each year. The survey was offered in English and Spanish and the results reflect households with and without internet access.
“The improvements in affordability between 2019 and 2022 emerged after temporary new policies protected and expanded access to public or subsidized coverage,” the researchers found. “However, pandemic-era changes to the health insurance policy landscape have expired or are expected to expire in the coming years, which could halt recent progress in making healthcare more affordable.”
The results showed that the affordability of healthcare improved during the pandemic period. After two years without major progress, the percentage of adults struggling to pay family medical bills and forgoing care has decreased.
As of December 2019, 18.7% of adults reported having trouble paying for medical bills in the past year. As of December 2022, this share had decreased to 15.0%. Similarly, a smaller population of adults reported forgoing care due to affordability. While 18.5% of adults reported using this strategy in 2019, 13.9% reported the same in 2022.
Low-income households have seen their unmet needs decrease. For people with incomes below 100% of the federal poverty level (FPL), the share of individuals with unmet care needs dropped from 27.2% to 18.8%.
For adults with incomes between 100 and 200 percent of FPL, difficulty paying for family medical bills decreased from 32.4 percent of the population in 2019 to 24.9 percent in 2022. Individuals in this income have seen a decrease in unmet care needs, with the share of this population experiencing unmet needs falling from 31.9% to 24.1%.
Even higher-income households have seen health care affordability improve. Reports of difficulty paying medical bills decreased from 10.1% to 6.1% and reports of unmet care needs decreased from 9.3% to 6.3% for adults with incomes at or above 400% of the FPL.
While the coronavirus pandemic has deepened care disparities in some metrics, minorities and underprivileged populations have seen improved health equity in the affordability of health care during this time period. Black and Hispanic adults were less likely to report problems paying family medical bills or opting out of care, narrowing the gap between them and white adults.
For example, in 2019, 22.7% of Hispanic adults had difficulty paying for family medical bills. By 2022, 17.0% of the population struggled with this.
In 2019, black adults were more likely than white adults to report problems paying medical bills by 7.4 percentage points. Nearly a quarter of Black adults at the time reported this challenge. By 2022, however, the rates of adults having trouble paying for medical bills were nearly equal among black and white Americans (15.9 percent and 14.2 percent, respectively).
The researchers attributed these gains to policies that stopped Medicaid cancellation and federal benefits. However, the gains could also reflect the fact that adults have stopped using care as frequently during the pandemic. Federal and state actions to extend these policies or improve existing policies could help continue the positive trends.
“The relative importance of different policies and factors in explaining recent improvements in health care affordability is not known, but the reduction in underinsuredness during the COVID-19 pandemic suggests that policies that protect insurance coverage may mitigate the impact of future economic downturns or public health crises, the report concluded.
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