79 million US adults have medical bill problems or are paying off medical debt

• Among the medical bill problems reported in the survey: 28 percent are paying off medical bills over time, up from 21 percent in 2005, and 27 percent of adults under age 65 said they had problems paying or were unable to pay their bills in 2007, up from 23 percent in 2005.
• More than half (53%) of insured working-age adults who have deductibles that represent 5 percent or more of their income reported medical bill burdens and debt; one-third of adults with lower deductibles face these kinds of difficulties.
• While adults in families with incomes under $20,000 a year report the highest rates of lacking coverage during the year, more adults in moderate income families are going without insurance. In 2007, 41 percent of adults in families earning between $20,000 and $40,000 a year reported a time uninsured during the year, up from 28 percent in 2001.
• Most people who were uninsured at any point in the last year are in working families. Of the estimated 50 million American adults who were uninsured in the last year, 58% were in families where at least one person was working full-time.
• People who are uninsured or underinsured experience inefficient care; nearly half of adults (47%) under age 65 who had gaps in their health insurance or were underinsured reported they had experienced problems such as test results not being available on time, receiving duplicate medical tests, and delays in receiving results of abnormal test results; in contrast just 26 percent of adults who are adequately insured reported these inefficiencies.

Methodology

Data come from the Commonwealth Fund Biennial Health Insurance Survey (2007), a national telephone survey conducted June 6 through October 24, 2007 among a nationally representative sample of 3,501 adults age 19 and older living in the continental United States. The 25-minute telephone interviews were completed in both English and Spanish, according to the preference of the respondent. The survey achieved a 45-percent response rate (calculated according to the standards of the American Association for Public Opinion Research). The survey sample was drawn using standard list-assisted random digit dialing methodology, which selected telephone numbers disproportionately from area-code/exchange combinations with higher-than-average density of low-income households. Using this stratified sampling design, this study obtained an oversample of low-income, African American and Hispanic adults. To correct for the disproportionate sample design and make the final total sample results representative of all adults age 19 and older living in the continental U.S, the data are weighted by age, sex, race/ethnicity, education, household size, and geographic region, using the U.S. Census Bureau's 2006 Annual Social and Economic Supplement (ASEC). The report restricts the analysis to the 2,616 respondents under age 65. The resulting weighted sample is representative of the approximately 177 million adults ages 19 to 64. The survey has an overall margin of sampling error of ±2 percent at the 95 percent confidence level.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.