Medical Costs Continue to Burden American Families

December 29, 2011 ( - More than one in five Americans were in families with problems paying medical bills in 2010.


This is about the same proportion as in 2007, according to a national study released by the Center for Studying Health System Change (HSC) and funded by the Robert Wood Johnson Foundation (RWJF).

While problems paying medical bills stabilized in recent years, the proportion of  Americans in families with medical bill problems remained significantly higher in 2010 compared with 2003—20.9% versus 15.1%, according to findings from HSC’s 2010 Health Tracking Household Survey, a nationally representative survey with information on 17,000 people. Funded by RWJF, the survey for the first time included a cell phone sample to account for the growing number of households without a landline phone. Response rates were 45 % for the landline sample and 29% for the cell phone sample.

Many people in families with problems paying medical bills in 2010 experienced severe financial consequences from their medical debt, with about two-thirds reporting problems paying for other necessities and a quarter considering bankruptcy, the study found.

“Given the recession, the sluggish recovery and health care costs continuing to increase faster than incomes, it’s a bit surprising that the rate of medical bill problems didn’t increase,” said HSC Senior Researcher Anna Sommers, Ph.D., coauthor of the study with Peter J. Cunningham, Ph.D., HSC director of quantitative research.


“The steady rate of medical bill problems may be a byproduct of decreased use of medical care—both by people who lost jobs and health insurance during the recession and others who cut back on medical care in the face of uncertain economic times,” Sommers said.

Other key findings include:

  • Marking a significant upward trend, the proportion of people 65 and older with medical bill problems rose from 6.9% in 2003 to 10.3% in 2010.
  • Underscoring uninsured people’s lack of financial protection from health care expenses, uninsured children and working-age adults (aged 0-64) in 2010 were more likely to have medical bill problems (31.5%) than their insured counterparts (20.2%).
  • Problems paying medical bills can create financial barriers to needed medical care. Among insured people, 9.2% of those with medical bill problems reported unmet medical needs because of cost concerns in 2010, compared to 1.4% of those with no medical bill problems. Among uninsured people, 27.9% of those with medical bill problems reported unmet needs, compared to 8.9 % of uninsured people with no medical bill problems.
  • The proportion of children and working-age adults in low-income families—those below 138 percent of poverty, or $30,429 for a family of four in 2010—with medical bill problems grew significantly between 2003 and 2010 from 23.7% to 29.2%.
  • A similar trend occurred for nonelderly people in families with incomes between 138 percent and 399 percent of poverty, with the proportion with medical bill problems growing from 19.7 percent in 2003 to 29.2 percent in 2010.
  • In contrast, the proportion of children and working-age adults in higher-income families—those with incomes at or above 400 percent of poverty—is much lower and was about the same in 2003 and 2010 (7.9% vs. 9.2%).


Provisions in the 2010 Patient Protection and Affordable Care Act are likely to reduce—but not eliminate—financial pressures related to paying medical bills for families with incomes below 400 percent of poverty, the study points out.

 In 2014, almost all people with incomes less than 138% of poverty will be eligible for Medicaid. Likewise, federal subsidies to purchase private coverage through state health insurance exchanges will be available in 2014 for people with incomes between 138% and 399% of poverty without access to employer coverage.

The study also notes that underlying growth in health care spending will be an important factor in whether more Americans face problems paying medicals bills, concluding, “If wages continue to stagnate and health care costs continue to grow faster than real income, the financial burden of health care likely will grow more acute.”