what are the financial implications of not having insurance?
For many uninsured people, the costs of health insurance and medical care are compared with equally essential needs, such as housing, food and transportation to work, and many uninsured adults report being very or moderately concerned about paying the expenses monthly basics, such as rent or other housing costs and monthly bills.1 When uninsured people use health care, they may be charged the full cost of that care (rather than insurers, who negotiate discounts), and often , face difficulties in paying medical bills. Providers absorb some of the cost of care for the uninsured, and while uncompensated care funds cover some of those costs, these funds do not fully offset the cost of care for the uninsured.
Most uninsured people do not receive free or reduced-price health care. Hospitals typically charge uninsured patients two to four times what health insurers and public programs actually pay for hospital services.2, 3 In 2015, only 27% of uninsured adults reported receiving free or reduced-cost care.4
People without insurance are often required to pay “up front” before services are provided. When people without health coverage are unable to pay the entire medical bill in cash at the time of service, they can sometimes negotiate a payment schedule with a provider, pay with credit cards (often with high interest rates), or be turned down.5,6 Among uninsured adults in 2015, one-third (33%) were asked you to pay the full cost of medical care before they could see a doctor.7
People without health insurance have lower medical costs than those with insurance, but pay a much higher portion of their medical costs out of pocket. Non-seniors without health coverage had an average of $1,719 in health expenses in 2016, less than half the average annual expense for people with some private coverage ($4,846) and less than a third of the average annual expense for people with only coverage ($6,421).8 Those insurers who use the services pay a higher percentage of their out-of-pocket expenses than those who have insurance. As a result, in 2014, those without insurance who used medical services paid an average of $752 out of pocket, compared to $658 for those with private coverage and just $236 for those with public coverage.9
Providers incur billions in the cost of uncompensated care for the uninsured, which is not fully offset by funds to defray these costs. in 2013, before Before the ACA was fully implemented, the uncompensated costs of care for the uninsured amounted to about $85 billion, and funding from various sources helped providers defray these costs. Most of these funds came from the federal government through a variety of programs including Medicaid and Medicare Disproportionate Share Hospital Payments (DSH), the Veterans Health Administration, the Indian Health Service, the community health programs and the ryan white care act, although states and localities provided billions and the private sector provided a small portion. Given the high cost of hospital care, most of the cost of uncompensated care is incurred in hospitals. Although substantial, these payments to providers for uncompensated care represent a small portion of total US health care spending. uu.10
With the expansion of coverage under ACA, providers in states that expanded Medicaid are seeing reductions in uncompensated costs of care. For example, between 2013 and 2015, the total costs of uncompensated care for hospitals (including charity health care costs and bad debts) fell from $37.3 billion to $28.7 billion, a drop of $8.6 billion or 23%.11 states that expanded medicaid saw larger declines in uncompensated care than states that have not. , the aca called for a reduction in federal medicaid dsh payments; these cuts were postponed and are now scheduled to begin in 2020.13
Not having insurance leaves people at a higher risk of financial strain due to medical bills. In 2017, non-senior adults without insurance were more than twice as likely as those with insurance to have trouble paying medical bills (29% vs. 14%, Figure 10) with nearly two-thirds of the uninsured having trouble paying medical bills and unable to pay their medical bills at all (65%).14 adults The uninsured are also more likely to face negative consequences from medical bills, such as running out of savings, having trouble paying for necessities, borrowing money, or sending medical bills to collection.15
Most uninsured people have few, if any, savings or assets that they can easily use to pay for health care costs. Uninsured people generally have limited access to funds to finance care. only 40 percent and 50 percent of single-person and multi-person households with one uninsured person, respectively, had liquid assets above $1,000 in 2016, and less than one-fifth (18 percent) in both types of households had liquid assets liquids over $5,000.16 non-seniors uninsured adults are more than twice as likely as insured adults to worry about being able to afford regular health care costs (61% vs. 27%; Figure 10). Additionally, more than three-quarters of uninsured non-elderly adults (76%) say they are very or somewhat concerned about paying medical bills if they get sick or have an accident, compared to 45% of insured adults. 17
People without insurance are at risk for medical debt. Like any bill, when medical bills are not paid or are paid too slowly, they are turned over to a collection agency. Nearly three in five consumers (59%) reported being contacted regarding a collection of medical bills in the United States.18 In 2017, uninsured adults were more likely than insured adults to say they have medical bills that are due. are paying over time (31% vs. 24%).19 More than half (53%) of the uninsured said they had trouble paying household medical bills in the past year.20