The silent affordability crisis facing sick people

People with major medical illnesses are having serious problems paying for the health care they need — a crisis that is flying under the radar while attention is focused on hot policy issues like the Affordable Care Act and "Medicare for All."

The big picture: A survey by the Kaiser Family Foundation and the Los Angeles Times shows that a strikingly large share of people with serious medical conditions are struggling to pay their medical bills, often wreaking havoc with their family budgets and causing them to cut back on care.

By the numbers: Take people with employer coverage who have a chronic condition such as hypertension, asthma, a serious mental health condition, diabetes, heart disease or cancer. It’s not a small group; just over half of those with employer coverage say someone in their family is currently receiving treatment for one of these or another chronic condition.

• 6 out of 10 people in this group report that they or a family member skipped or postponed medical care or prescription drugs they needed because of costs, or tried a home remedy instead.
• High deductibles can make things worse: Among those with chronic conditions whose deductibles are at least $3,000 for an individual or $5,000 for a family, three-quarters report skipping or postponing some type of care.
• About half — 49% — say they or a family member had problems paying medical bills or difficulty affording their premiums, deductibles or co-pays in the last year.

There are ripple effects on family budgets, too. A substantial share of people reported taking measures such as increasing credit card debt (28%), using up most of their savings (26%), taking an extra job (19%), and borrowing money from others (14%) to pay for health care or insurance costs.

And this was over the last year. We ask the question that way because people can more easily remember more recent experiences. It’s not hard to imagine that the share of people with chronic conditions who experience these problems over the course of a longer time period is much higher.

People who do not have serious illnesses also struggle with affordability challenges, but fewer of them do (29%). Their worries that they will get sick and not be able to pay their bills fuels health care as a political issue.

The bottom line: It may not be surprising that people who are sick have more problems; they use more care. But it is the opposite of how a compassionate and functional insurance system should work.