With consumer premiums continuing to rise and doctors' reimbursement continuing to decrease, perhaps its not healthcare reform we need. Perhaps what we really need is insurance reform as the industry continues to report windfall profits at the expense of patients and their doctors.

One in Five Struggles to Pay Medical Bills

By Emily P. Walker, Washington Correspondent, MedPage Today Published: December 29, 2011

WASHINGTON -- One American in five reported having trouble paying medical bills in 2010, according to a study by the Center for Studying Health System Change. That proportion didn't change much from 2007 to 2010 -- a somewhat surprising finding, according to the study authors, given that the period was the peak of the economic recession. "Given the recession, the sluggish recovery, and healthcare costs continuing to increase faster than incomes, it's a bit surprising that the rate of medical bill problems didn't increase," Anna Sommers, PhD, co-author of the study, said in a press release. One reason may be that people cut back on medical services -- such as visiting a doctor -- during the recession, something that other studies have confirmed. On the other hand, compared with 2003, the percentage of families with problems paying medical bills in 2010 was significantly higher (15% versus 21%). That increase reflects the rise in the cost of healthcare, which grew faster than salaries and the U.S. economy as a whole, wrote Sommers and co-author Peter Cunningham, PhD. The findings came from the center's 2010 Health Tracking Household telephone survey of a nationally representative sample of 17,000 people. Respondents were asked, "During the past 12 months, have you or your family had any problems paying medical bills?" Among the 21% of people who reported having trouble, the average medical debt for the family was $6,500. More than half of respondents in that group expected it to take more than a year to pay off the bills; 17% said paying down their medical debt would take longer than five years. There were no statistically significant changes in the amount of per-family debt reported from 2007 to 2010. The study found that people without insurance were more likely to have bill-paying problems than people with insurance (31.5% vs. 20.2%). The study also found that among insured people, 9.2% of those who had problems paying medical bills reported not meeting their medical needs because of cost concerns. The study showed that the proportion of people 65 and older with medical bill problems rose from 6.9% in 2003 to 10.3% in 2010, even though people in that age group were eligible for Medicare. Almost all people who reported having problems paying their medical bills reported having "serious financial consequences" as a result. In all, 66% of respondents said medical bills caused them to be unable to buy other necessities; 52% said they had to postpone a major purchase; half borrowed money; nearly two-thirds took money out of savings; and nearly two-thirds were contacted by a collection agency. The study authors said that the Affordable Care Act (ACA) is likely to reduce, but not eliminate, financial pressures of paying for medical bills, especially for families with incomes below 400% of the poverty level. As a result of the ACA, starting in 2014, people who earn less than 133% of the federal poverty level will be able to enroll in Medicaid, and those who are between 133% and 400% of the poverty level will be eligible for tax credits from the federal government to help them buy health insurance. Whether Americans will continue to struggle to pay medical bills likely will depend on growth in healthcare spending, the authors concluded. "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," Sommers and Cunningham concluded. The study performed by the Center for Health System Change, which is affiliated with Mathematica Policy Research and based in Washington DC. It was funded by the Robert Wood Johnson Foundation.