It’s common for patients to delay or skip medical care due to high costs in the US—but data shows that fewer adults have done so in recent years.
Between 2019 and 2022, the percentage of adults who reported delaying or skipping care fell to 9.7% (about 19 million people), down from 12.1% (about 24 million people), according to an early July study conducted by think tank the Urban Institute. Researchers found that policies implemented by the federal government during the Covid-19 pandemic reduced cost barriers and made it easier for more people to afford care.
The policies increased the number of insured adults in the US, which “has a really good impact on people’s health,” particularly for those managing chronic conditions, Katherine Hempstead, a senior policy advisor at philanthropic organization the Robert Wood Johnson Foundation, which funded the study, told Healthcare Brew.
“When people are not motivated to avoid seeking care” because they’re worried they’ll get a bill they can’t afford or they’re uninsured, it’s easier to take care of their health, she said. “They’re much better able to get medicines that are going to keep them healthy so that they can work.”
Breaking it down: The study analyzed three factors that helped reduce costs: Medicaid’s continuous coverage requirement, larger Affordable Care Act marketplace premium tax credits under the 2021 American Rescue Plan Act (ARPA), and Medicaid expansions in several states.
The continuous coverage requirement that began in March 2020 allowed all Medicaid enrollees nationwide to keep their coverage through its duration, while ARPA gave tax credits to households with low incomes (below 400% of the federal poverty level) to decrease premiums in the marketplace. And by expanding Medicaid, the law also gave more patients in certain states access to health insurance.
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Due to these policies and the increased access they afforded, the percentage of uninsured adults in the US fell to 12.4% in 2022 from 14.5% in 2019, according to the study.
With more affordable options, roughly 5 million fewer adults reported delayed or skipped seeking care in those years, according to the study. A smaller share of patients said they had skipped filling their prescriptions due to cost as well, declining to 7.5% in 2022 from 9.8% in 2019.
Demographics that saw the biggest benefit were households making less than 138% of the federal poverty level and residents in states that expanded Medicaid coverage during that period, according to the research.
The percentage of low-income households that reported delaying or skipping care fell from 20.3% to 14.9% over that same period, the researchers found. And in seven Medicaid-expanded states, the percentage of people reporting delayed or foregone care fell 36%.
The caveat: The Medicaid continuous coverage requirement ended in April 2023, and the larger marketplace premium tax credits are set to expire after 2025 unless renewed. Facing these changes, it could be challenging to sustain the progress that has been made, the researchers noted.
Roughly 24 million people have already lost Medicaid coverage during the unwinding process, according to data from nonprofit health policy research organization KFF.
“Continuous coverage, it’s a big deal. It covered a ton of people and made a really big difference,” Hempstead said. “A lot of people then are getting dumped out of coverage, and unfortunately, that makes a big difference, too.”