This brief examines trends in health care affordability using a nationally representative survey of adults ages 18 to 64. We estimated changes during the COVID-19 pandemic and the years leading up to it for two affordability measures: 1) the share of adults reporting they or their families had problems paying or were unable to pay medical bills in the past 12 months, and 2) the share of adults reporting unmet needs for medical care because of costs in the past 12 months.

WHY THIS MATTERS

The federal response to the COVID-19 pandemic provided households with significant financial assistance and protected access to health insurance coverage. For instance, the Families First Coronavirus Response Act of March 2020 prohibited states from disenrolling people from Medicaid during the public health emergency. These initiatives were designed to help households afford health care despite widespread economic disruption.

As the Medicaid continuous coverage requirement expires, millions of people could lose Medicaid and face greater difficulty paying for care. Understanding recent trends in health care affordability can help policymakers assess the temporary coverage protections and safety net supports implemented during the pandemic and the potential effects of new strategies to ensure coverage continuity.

WHAT WE FOUND

• Health care affordability improved between 2019 and 2022.
  • Between December 2019 and December 2022, the share of adults reporting problems paying family medical bills in the past 12 months declined from 18.7 percent to 15.0 percent.
  • The share of adults who reported forgoing needed medical care because of costs in the past 12 months declined from 18.5 percent to 13.9 percent.
  • These improvements in affordability represented a break from the previous trend in the years just before the pandemic. The shares of adults with problems paying medical bills and unmet needs for care were essentially unchanged between 2017 and 2019.
• Racial and ethnic disparities in health care affordability narrowed.
  • The share of Black and Hispanic/Latinx adults reporting problems paying family medical bills and forgoing needed medical care because of cost decreased sharply between 2019 and 2022. As a result, Black and Hispanic/Latinx adults reported these challenges at rates closer to those of white adults in December 2022.
• Health care affordability gains reached families with low and high incomes.
  • Adults with family incomes between 100 and 200 percent of the federal poverty level (FPL) reported the largest reduction in problems paying family medical bills (from 32.4 percent to 24.9 percent).
  • The decrease in unmet needs for care was largest among adults with incomes below 100 percent of FPL (from 27.2 percent to 18.8 percent) and incomes between 100 and 200 percent of FPL (from 31.9 percent to 24.1 percent).
  • Adults with incomes of 400 percent of FPL or more reported significant declines in both problems paying medical bills (from 10.1 percent to 6.1 percent) and unmet needs for care (from 9.3 percent to 6.3 percent).

HOW WE DID IT

Our analysis draws on data from the Urban Institute’s Well-Being and Basic Needs Survey, a nationally representative internet-based survey of adults ages 18 to 64 designed to monitor changes in individual and family well-being as policymakers consider changes to federal safety net programs. The survey is fielded annually in December, and approximately 7,500 adults participate in each survey round. For this analysis, we used data from all survey rounds between 2017 and 2022.