Signs of a Decline in Financial Distress Connected to Medical Bills

Jan 15, 2015 · 67 comments
John Joseph Laffiteau MS in Econ (APS08)
I) According to Maslow's pyramid of needs, the two most essential needs for people are: 1) Biological and Physiological needs; and 2) Safety needs, including stability and freedom from fear. Thus, the growth in breadth of the ACA's coverage does seem to indeed have helped many individuals to gain a greater sense of mastery over their health outcomes, which helps these individuals fulfill Maslow's fundamental needs. [Numerous studies have shown that insured individuals have better hospital outcomes by morbidity and lethality metrics; than the uninsured.] II) Economically, this result could be termed Pareto efficient; meaning in society overall, fewer such improvements can be made, or are now needed. III) To discourage "unnecessary" health-care expenditures, copays are increased along with deductibles to decrease the consumer's insurance subsidy levels. This increased cost for the consumer's budget should discourage use of health-care services. So, health-care expenditures theoretically remain "discretionary" expenditures and supposedly subject to the consumer's volition. IV) Again, purely in economic terms and cost/benefit comparisons, do these increased marginal consumer costs discourage medical service usage to the point that compensating for the omitted health care services, because of higher copays, for instance; is more costly than the savings from reduced usage and revenue gains from the higher copays? [{JJL}; 01/15/2015 Thurs 6:00 p.m.; Greenville NC]
DaveG (New York City)
An article like this one could only occur in the US. It's patting the US health care system on the back for being twice as expensive as the average for advanced countries, and for deductibles that don't exist elsewhere. It's pathetic.

We need a single-payer system. Period.

PBS, "The News Hour", "Health Costs: How the US Compares With Other Countries":
A Goldstein (Portland)
The need for health care is one of the very few things that can bankrupt you in an instant if you are not insured. Of course, you can choose to suffer the consequences....death.
paul (brooklyn) our peer countries the ACA is a poor competitor...

However, against the Republican de facto criminal plan of be rich or else don't suffer a bad life event, it is a life saver for many people.
I'm sorry but this survey is meaningless to those of us who actually have to pay for health insurance, if you have Medicaid of course why would you worry about the cost!
What has been happening and it would be great if the geniuses at the NYT would report that many employers are forcing employees into high-deductible health plans/health savings accounts(HDHP-HSA) that come with modest premium reductions and exorbitant out-of-pocket maximums. These employers contribute very little in the way of wage increases or subsidies to fund these "consumer-driven" health plans.
What really adds insult to injury the employer will give a vague excuse that the ACA requires these changes but never states the provisions in the law that specifically require what is basically a pay cut. I thought if you liked your health insurance you could keep your health insurance, apparently not.
Fourier (Miichigan)
The push to "consumer-driven" health plans began well before the ACA and, as you surmise, is no more than a way for employers to reduce what they spend on health insurance by transferring costs to the employee. The plans often come with an employer-funded health savings account, but the health savings account is always several thousand dollars smaller than the deductible (e.g. deductible of $5000, health savings account of $3000).

The rationale behind the plans is that the deductible will deter unnecessary medical care or encourage employees to find lower-cost alternatives, as if there were some kind of competitive health care marketplace; the reality is that the lower paid employees, who can't cover the deductible, do without, while the higher-paid, such as the people who decide to implement the plan, are not really bothered.

Our public policy is dominated by mythology. The two myths here are (1) there is a competitive market for health care (there isn't) and (2) people can self-diagnose and know when they can self-treat (most people go to the doctor to find out what the problem is and only know if the visit was unnecessary after the fact). Anyone who has looked into the provision of medical care knows that they are myths, but as long as they are convenient for employers they will be repeated.
Dean Kagawa (Tampa Fl)
yup. Totally agree with your two myths....
Lily (Philly)
As someone who has greatly benefited from the ACA, now I am feeling guilty. Most of my friends are paying more, in one case much more for their care. We all supported the concept the plan, a couple were suspicious that it couldn't work. Now it is appearant to us all that Medicare for all is the only way we can provide healthcare to all on an equal basis. Healthcare should never be for profit and I should not feel guilty to have my health back.
Jonathan (NYC)
How is it possible to provide medical care on an 'equal basis'? The rich and powerful will always get better care than the poor. That is just how the world works.
Medicare for all would not work, since Medicare is highly subsidized by private insurance. If everyone had Medicare, there would be no other insured party onto whom to shift the amounts that Medicare does not currently pay. Ditto Medicaid.

Don't feel guilty about benefiting from the ACA. It is working as it was supposed to. Many who are paying more for insurance didn't realize how little their previous insurance would have covered had they had a serious accident or illness. In any case, you didn't make the rules.

Most of us have, at some time in our lives, depended upon assistance from the government, and the way in which our taxation and aid systems are partitioned can sometimes mean that those who are subsidized in one area are the subsidizers in another, which can add up to a net 'loss' in terms of payment vs. benefits, rather than a net 'gain', despite how it looks to others. As an example, my household paid the maximum SS tax, which is likely not enough to fund our future benefits, so it may look as if we will get a subsidy there, but we consistently pay, aside from SS and Medicare taxes, more than the median family income in federal income tax, and our relatively high post-retirement income will mean full taxation of our SS benefits, as well, so determining what the actual subsidy, if any, is, can be quite difficult. Without the taxpayer-subsidized federal education loans that funded our educations, however, we wouldn't be as well off as we are.
AKLady (AK)
No, that is how this country works.

America is the only modern. developed country in which people are allowed to die simply because they cannot afford medical care.

What the selfish, fearful American does not understand is that the for profit medical system is costing them a fortune, even if they are healthy and rarely see a doctor.

People who cannot obtain care when needed, become disabled. At that point, Americans are taxed to pay Supplemental Security Income (SSI), Social Security Disability Income (SSDI), Medicare, Medicaid, Food Stamps and eventually burial expenses.
ak (new mexico)
I just spent 16 days in hospital due to emergency surgery and complications therein. I have countless doctors appointments for follow up, including 2 weeks of daily IV antibiotics for a surgery-related infection (@$250/day). The first bill has come in--$1746 for anesthesiology; insurance covered $746. They start with the small bills...
My husband and I purchased health insurance from the Exchange. We're both self-employed and although comfortable, don't make a ton of dough. The insurance is expensive. But anticipating $150-200,000 worth of bills when all is said and done, we breathe a sigh of relief to know that our out-of-pocket costs are capped at $6,350 annually. Before the ACA, there was no set out-of-pocket cap on our insurance. While the ACA leaves much to be desired, at least we won't be bankrupt and I'm not dead.
Dean Kagawa (Tampa Fl)
ACA is doing what is was supposed to do.....
Bubba (Texas)
Thanks for this article. This sort of data is useful, and we need to see (and have explained) periodic updates and comparisons with other surveys.

Obamacare is not the final answer to our medical needs, but is certainly one meaningful step. I agree with the comments that we should be negotiating drug prices. It is also important to comparison shop before getting medical services, which is difficult in the medical field, especially when we need help fast. Hospitals do charge more. Avoid them when you can! Local drug stores offer less expensive vaccines and other care. Deductibles can be abusive, but they can also be useful as long as they are at reasonable levels. What deductibles do is make us ask if a treatment is useful or the most efficient, and they force us to comparison shop. Such "shopping" for medical care is in some way a shame on us. But given that we do not have a choice right now, we all need to learn how to seek out the most affordable quality care. Some companies have been organized to do this (Compass Profession Health Services is one)-- mostly for large employers, but also for individuals. They find out prices that we as individuals are often not able to discover and show us our choices. As we force the market to work (which is far from perfect, but better than nothing) we can get the providers to compete by lowering prices. This has worked for the Europeans.
Cee (NYC)
The ACA is a step in the right direction.

Still, single payer is the long term rational option.

Doesn't insurance company being required to spend only 80% of premiums on claims build in a 20% gross margin for "administration"?

Then, why is an insurance clerk making a medical decision with your doctor as to what care or what medicine you can get?

Single Payer System
small business owner (texas)
I find the insistence on a single payer system baffling. They can't manage the ACA now, and the VA is a disaster, but hey, lets make another massive program! Money be damned, full speed ahead. Of course, lots of civil servants will get their money and bonuses for all the good work.
K Henderson (NYC)

The question for many is "Will ACA still be around in 4 years?"

I wouldnt place bets either way given the political climate.
Tom Maguire (CT)
Their mission, as presented at the Commonwealth website linked in the article:

"The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults."

So ACA cheerleaders put out a study showing the ACA is working! Thank heaven this wasn't a study praising a new drug that was funded by Big Pharma or folks would notice a modest conflict of interest.
B (Minneapolis)
Tom: You quit quoting the Commonwealth's mission statement right before the sentence -"The Fund carries out this mandate by supporting independent research on health care issues". Did that not fit the narrative you were trying to create?

Those of us who have worked on health policy issues for years know that the Commonwealth Fund has a long history of credibility and has been conducting the same survey for years. BTW, just what is wrong with promoting " a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults."?
small business owner (texas)
Credibility in whose eyes? Yours because you agree with it? I don't trust them at all. We have no idea how well the ACA is doing and probably will not know until we start getting some FOIA back. Potemkin villages all the way down.
Bohemienne (USA)
Do these surveys actually seek documented financial information or do they merely ask for subjective responses on the part of respondents?

I know people who say they are in financial trouble due to "medical bills" they easily could have paid if not for imprudent purchases, trips to Disney or Vegas and other discretionary spending. Yet it's the health care expenses they will blame and begrudge -- the dollars to keep themselves alive and kicking -- while licking their chops over the next casino outing, large-screen TV or smartphone with a $100/month service tab.

I've nothing against extending medical care to all and indeed think we should have Medicare for every citizen, well-subsidized for low-income people. But I do have contempt for journalists who unquestioningly perpetuate these same-old personal finance memes without doing any real reporting. Many people would be able to afford "medical bills" and even the premiums for decent health insurance if their spending priorities weren't based on wants instead of needs.
AKLady (AK)
America has the world's most expensive health care system. It is the only modern, developed country in which people are allowed to die -- simply because they cannot afford health care.

Americans have been subjected to negative propaganda regarding socialized medicine. Selfishness and ignorance will continue to cause death and disability.

Years of Social Security Disability Income (SSDI) and/or Supplemental Security Income (SSI) is far more costly to the tax payer. But, no, we would rather buy guns, tanks and planes for war.
alan Brown (new york, NY)
The main change in access with the ACA is a vast increase in second rate care provided by the increase in the Medicaid rolls. This accounts for fewer people having problems with medical bills but hasn't improved the quality of care and for many there are increased premiums and huge deductibles but these are dwarfed by the increase in Medicaid numbers. The continued unpopularity of the law is guaranteed and will persist until a single payer system is in place. Don't hold your breath.
Jonathan (NYC)
Do you think highly skilled doctors are going to take the measly fees offered by Medicaid? An increasing number of physicians don't accept any insurance at all, and they have plenty of patients.
small business owner (texas)
We used to have a dental office. We always took medicaid because we felt it was the right thing to do. Besides the low reimbursement the patients were a lot of trouble, especially not showing up for appointments. Every time they didn't show it was a loss for us. They did not care, they weren't paying for it. We had overhead, loans, payroll, insurance. If we opened today I would recommend not taking medicaid until some changes were made.
Dawn Prevete (Atlanta)
Interesting, and the polar opposite of the results of Gallup November 28, 2014 survey ( on the same topic.

Gallup found a record 33% of Americans had put off medical care due to cost and that 22% - the highest ever - had put of care for serious conditions.
More people with private insurance put off care in 2014 than in 2013 - an increase to 34% in 2014 from 25% in 2013.

Gallup found that only in the lowest income group (annual income under $30,000) did the percentage of people avoiding care due to affordability drop. In other income groups it rose, anywhere from 5% to 11%.

Gallup interviewed 828 people in 50 states plus the District of Columbia (50% landline and 50% cell phone.)
Common Sense (New York City)
Indeed interesting. To me this shows the unintended (or perhaps) intended consequence of further burdening people who seem relatively well off but are truly, even while earning $70k a year, just a few paychecks away from disaster. Until income disparities are corrected -- no raises in 6 years, while corporations have come back roaring, as just one example -- this will persist.

"Affordable" in Affordable Care Act is clearly a matter of perspective. My insurance premiums, co-pays and other out of pocket expenses keep going up. The assumption is that the depth of my pockets is limitless.
RichWa (Banks, OR)
If one bothers to do some critical thinking, one finds the results are not "polar opposite" and the comparison is comparing apples with oranges. First, a poll, as per Gallop is not the same as a survey as per The Commonwealth Fund. Second, the Gallup pole is about putting off care while the survey due to the initial expense whereas the survey done by The Commonwealth Fund concerns the financial after effects of having required medical care done.
B (Minneapolis)
Dawn, you reported the sample size so should have realized Gallup's survey was a small sample survey to represent the full US population. The Commonwealth Survey sample is many times larger.
Look at the link to additional detail in the Gallup survey and you will see they report that the overall error rate is plus or minus 4%. On the question that combines whether someone reports that they had difficulty due to cost and then asks whether the condition was serious or not, the error rate reported by Gallup is plus or minus 8 percent. That means that annual reports can vary on the first question by 8% and on the second question by 16% and not be different. In fact, the responses to each question changed by 3%. I would not give that any credibility.
Also, look at the one-year increase from 17% to 28% in people earning $75,000+ who reported difficulty in paying for medical care due to serious medical conditions. First, the big change is most likely due to sampling error. Second, look at the detailed question and you will see that the increase was entirely due to conditions respondents reported as "not very serious". How many relatively well off individuals are going to have difficulty paying for not very serious conditions, which at most might cost them out-of-pocket the price of a TV?
Dougmat45 (Beaumont, Texas)
Regardless of the ever growing mountain of facts confirming the benefits to the ACA, the Republicans, believing more in their ideology, insist this law must be repealed.
D.A.Oh. (Midwest)
This is a train wreck. This makes it so much harder for me to be the big American dream winner if fewer people have to go to the poor farm. Now they are taking MY money even though I'm the only who works. Me, me, me!
ekdnyc (New York, NY)
the obamacare insurance is great if you're poor and the government is paying for it. if you're middle class (ha-ha), meaning you make $50K a year, you pay your own way and thanks to Obama, Pelosi and Reid colluding with the insurance and pharma companies who wrote the bill in the white house (shades of bush/cheney), obamacare is legalized extortion and affordable not in the least. $5K in premiums (up 16% this year), $6K in deductibles before anything is paid for, $70 per doctor visit copay (tripled from my non-obamacare policy), paying for pediatric dental insurance even though I don;t have children (a special outrage because I can't afford the dentist myself) and the charges never stop coming. does anybody who shills for obamacare have it? pay for your own obamacare policy and you'll learn to hate it and hate obama too. and I'm a Democrat (who voted for my first republican in the last election). bad policy is bad politics. obamacare is a disaster that the Dems will be paying for for years. hoping the supes throw it out and the next non-compromised Democratic president will give us what we want (not what the corporations want) and that's single payer, medicare for all NOW!
B. Rothman (NYC)
Ekdnyc, thanks to democratic voters not turning out to vote in 2010 the states went Republican and so did the congressional districting. Next chance to change Congress? 2020, maybe. While Republicans continue to nurse their hate for Obama, the Chinese are buying up properties in NYC and on the West Coast, our infrastructure continues to deteriorate, our schools become profit centers not educational centers, our planet continues to be polluted, our middle class loses jobs to the third world, our elected officials owe their jobs to the 1%, and the NRA continues to pressure elected officials into caving to the gun. And these are just a few of the things that occur as a democracy becomes an oligarchy. The voter is both the most important and the least important today.
Samsara (The West)
It is simply inhumane to face financial ruin just because you or a family member is sick or injured.
When will this country end its addiction to war and war machines and spend our wealth in ways that benefit ordinary American citizens?

It certainly won't happen as long as our politicians are addicted to the money shelled out by Big Medicine and Big Pharma.
pj (ny)
The affordable care act has increases my premium by 20% and added a $2000 deductible I never had prior.If you don't read your policy line by line you will be a VICTUM of paying out of pocket costs you can avoid. For example, if one needs an MRI it is LESS expensive to get it at a private imaging facility than at the hospital your doctor works for since there is a "coinsurance" one must pay the hospital, in addition to the co-payment. One may also be charged a "facility fee"(mine was $300) for an X-ray I was given in a hospital. The bill for the X-ray itself was separate and my insurer paid $19.00 for that. Then the procedure was denied even after an appeal so I am still living on medications that are cheaper to buy out of our country than from my plan. So my approximate $450 investment out of pocket has left me pretty much where I started. I was told that I could wait to the new calendar year and try again. Which I have.If the small procedure does not work I will need a spinal fusion but the doctors I have seen previous to the ACA are no longer in my HMO. Our government has always recommend GENERIC drugs. The AFFORDABLE CARE ACT promotes GENERIC PHYSICIANS. I am not saying that they are not capable, but my new more expensive insurance has given me less choices and decisions regarding my health care. I am 59 years old and I never thought 65 could sound so good.
Jjfoley (Phoenix)
That's why we need single payer….Medicare is the government too!
Not MD (New York, NY)
In Canada, the cost of medical care for an entire family costs from $100 to $150/month, for an entire family. Anyone can see any doctor, and there are no deductibles. and no copays, ever. If someone is unemployed, they have the same coverage, at no cost. There are no "clawback" provisions, so that the state can confiscate one's estate for medical bills, as exist under expanded Medicaid.

That's what we could have had, had we not been sold out by the Democratic Party. Instead, we have a pro-industry law, written by a WellPoint lobbyist named Liz Fowler. WellPoint's stock is up almost 60% since the ACA came online last November. And that important story has yet to be told.
Jonathan (NYC)
However, in Canada, the doctors are well-off, but they're not rich. Here in the US, of the top 1% in income, 16% are doctors.

So how can the average family afford to hire a guy who makes over $400K a year to provide services to them? They can't.
kernel85 (Rowan, IA)
Politics is the art of the possible.
LaylaS (Chicago, IL)
Perhaps Obamacare has been a boon for the previously uninsured, but for those of us that had reasonably-priced, inclusive policies before Obamacare, it's been a disaster--at least in Illinois. My family has had to put off much needed repairs to our house because uncovered medical costs have run into the thousands. We are just lucky that hospitals and doctors have been willing to forgive some of the costs.

I would say our financial distress has been exacerbated, not eased, by the ACA.
dfokdfok (Philadelphia, PA)
Under the ACA you now have a maximum out of pocket expense. "Low priced all inclusive" pre "Obamacare" policies did not have this protection, therefore many were subject to financial stress despite believing they were insured. If you actually signed up for an ACA plan likely you would not be facing a hardship because of uncovered medical costs.

Hospitals and doctors don't "forgive some of the costs", they push them off on the rest of us. That is why the Heritage Foundation wanted an insurance mandate all those years ago.
c. (md)
Having my income slashed by 50% since 2008, this year I applied through the ACA for medical insurance. I qualified for Medicaid and was able to continue with the same practitioner I have used for many years.
As a well educated person it would be preferable to not have to rely on the government for this help. I am 64 years old and have been contributing to the system for a long time. I have recovered from the guilt and shame somewhat. Next year at 65 I qualify for Medicare, not to sound cavalier, what does one years difference make.
Thank you.
BMM (Pennsylvania)
Anytime someone becomes more comfortable in their financial situation is a "win" for them, and for our country. Ignorance is not bliss - especially when it comes to money. Hooray for some aspects of the ACA - being able to continue coverage for dependents, forcing states to reexamine their lower income options to their citizens, opening up coverage, and affordably, for those that cannot get coverage from their employers. However, I am saddened that a huge piece of the process is missing - the deductibility from gross income for medical premiums paid. Employees have it deducted before their taxes are computed..... those who pay "out of pocket" for their premiums have no where to deduct it on their income tax returns - from gross wages. If they itemize on schedule A - they MIGHT be able to take a portion, of they exceed the 10% medical threshold. This is unfair to all taxpayers - it is unequal treatment for same item. Where is the outcry? Where is the news media reporting on this issue?
Alex (Chicago)
I agree with you. In 2008 only John McCain talked about this reality. I did not like McCain (still don't ) but I do credit him with pointing out the unfairness of the current situation.
AR (Virginia)
It had to happen. There was no way the growing crisis of financial ruination resulting from medical bills could continue to wreak havoc with ordinary people's lives. I personally know somebody who purchased a truly affordable health insurance plan through the ACA and was then able to receive top-quality care at a hospital that I'm sure all the upper-income elite people in town use. This person, out of desperation, was not forced to go to some "free" medical clinic or sub-par hospital. The ACA made this outcome possible.

This is the way things ought to be--a health care and insurance system that is de-commodified to an extent. It's all right for there to be a two-tier system for consumer shopping, with rich people paying inflated prices for goods at Saks Fifth Avenue while lower-income people go to Walmart. But it strikes me as totally unacceptable that such a two-tier system should exist for access to high-quality health care as well.

I realize that the insufferably obnoxious people who yell "I'm a maker, you're a moocher" are outraged by this development and would like to see health insurance treated like any other consumer product such as ice cream or flat screen TVs. But that is a recipe for disaster in society. Rich people live and exist in society, too. They can construct their gated communities and pretend it isn't so, but they MUST understand that it is not the destiny of the United States to end up looking like Haiti or Pakistan.
Eggplant (Minneapolis)
No doubt we'll see a chorus of calls to repeal the Affordable Care Act as data comes in showing little if any improvement in general health measures. Those calls are misguided. It's unlikely that we'll find any substantial uptick in general population health as a result of access to health insurance. The populations that most need regular health care - the elderly and disabled - already have it, through Medicare and, to a less certain degree, Medicaid. Not all, but most, previously uninsured people who gain coverage under the Affordable Care Act are likely in good health, and need coverage only for accidents or unexpected illnesses. They'll get peace of mind through the Affordable Care Act. That's worth something.
Wendy (New Jersey)
I would guess that the other measures may also improve over time. Preventive healthcare is not an instant gratification kind of solution to the myriad of problems we had with healthcare in this country prior to the ACA.
Cheryl (<br/>)
At least this reflects that huge numbers of people have to "struggle" with medical care costs. The ACA did hit it's mark of targeting the lowest income groups, but did nothing to control what insurance companies can charge or what employers can do to comply with the law at the most minimum levels. As M L Chadwick points out, typical Mainers - like people in many other low income areas, do not have the "discretionary" income to cover extra costs. I have heard workers in different settings blaming Obamacare for have been hit with gigantic increases in deductibles because of changes in coverage. What happened is that their employers changed the coverage offered, and the employer claimed it was required because of Obamacare. There was evert comprehensive discussion of the bill, no careful vetting of the pluses and minuses or fine tuning to prevent poor consequences ...
Remembering that wages for a majority of Americans are stuck, there is no magic bucket to pull these costs from. So many who may have employer coverage, which looks like a positive as a statistic, are already cautious about care, and hope that they do not have a serious illness that would add them to those who are indebted for Medical care. In some low wage jobs, the fall back becomes Medicaid/ subsidized insurance,
Frank Jones (Philadelphia)
Since the law went into effect the deficit has fallen, employment is up and more people have health insurance. The ACA improves the lives of millions of Americans. We would be bankrupt by now if not for the ACA.
George (New York)
Those are all good things, but can you provide any evidence of ACA being the sole reason??

Assigning credit for all that is good to one item of this very large, very complex economy may not be best way to fix this mess.
Ed (Wichita)
Great news that should be welcomed by all. I hope that the folks in congress who believe they were handed a mandate to roll back ACA, don't treat this observation (reduced financial stress) the same way they deny global warming.
Jim (North Carolina)
Could it be that health care is becoming affordable to more people? Who'd have thought that?
Thomas Payne (Cornelius, NC)
The law, as flawed as it is, is working. I hate to think where we might be if we had all parties pulling in one direction up there in DC.
Casey (New York, NY)
A telephone poll ? Really ?
A typical ACA plan, if you can find a doc who accepts ACA in the NY metro area, has a huge deductible. The bee sting, or the trip to ER for stitches, won't be covered. When the ACA person "needs a test", like an MRI or such, they won't have the money. After a year with an ACA plan, I ran back to a private plan for more money, as it was clearly insurance in name only. Worst of all, if you get hit by a huge disease, an 80/20 split or 70/30 split is still a trip to bankruptcy court. I was happier with my 10k deductible plan with full coverage above that amount.
Michael B (Cincinnati)
Sorry, but I don't think you understand what the ACA is. Insurance companies provide the plans that must conform to ACA regulations. So your comment really doesn't make much sense to me. There are a number of different plans out there and they are all "private" plans. There isn't a government plan.
Hilary (New York City)
And for all its flaws, the ACA has saved you from bankruptcy court by dint of the cap on total out of pocket expenses. You can still bleed to death, for sure, but it will be a lot slower!
kwb (Cumming, GA)
As I read this article, I find it hard to see it as other than another NYT puff piece ascribing the results to the ACA and providing opinions other than facts about what the results mean. The last sentence is a prime example of this.
Judy Wixted (Cordova, MD)
This article was data driven, unlike your opinion. You are entitled to your opinion but where are your facts?
The article is data-driven, but the "facts" are always suspect when the data is something like 'Percentage of people SAYING they were paying off an old medical bill'. They could be paying the amount they are responsible for under the ACA, or they could simply have decided not to pay it, or they could be struggling and say they weren't paying it because they haven't been able to make any payments. In other words, what people say is open to interpretation.

Insurance premiums should be included in medical costs, by the way. Not to worry, however, the ACA may be tweaked, but it won't be repealed.
Larry (Richmond VA)
What better way to keep employees desperate and docile than the constant threat of medical bankruptcy? The fact the it reduces workers' financial insecurity is the real beef conservatives have with ACA.
Saba (Montgomery, NY)
While I support the new healthcare legislation and definitely want everyone to have health insurance, Medicare Advantage in New York State has gotten to be much, much less of a support to seniors. Before the legislation, I had MediBlue, Blue Cross coverage that was good upstate or with New York City specialists when needed. Now, I am in a little HMO in a few upstate counties, and the rules about what get paid are designed to keep my out-of-pocket much higher. I was given wrong information so many times by Customer Service that I wrote to the CEO. That helped in the one instance, but I am still dependent upon this rickety HMO. Some New York City doctors are covered, but not the top hospitals. Sloan Kettering is not covered at all, I cannot find any Weill Cornell physicians that are covered. Step down insurance for those who cannot afford the real deal.

I live in Orange County, N.Y. I should have had insurance for life from the work that I did, but when I retired there was a snafu that caused me to lose coverage.

I am hoping some reporter will write in the Times about changes in NYS Medicare Advantage.
Todd (Williamsburg VA)
A six percent drop from 41% to 35% is terrific - we can assume Faux News will not report it - but it also highlights the work left to be done and one other thing: The Affordable Care Act, as much as many have defended it because of the dirge of attacks on it by recalcitrant opponents, is highly imperfect. There has been no opportunity for it to evolve or be improved while it is under such attack, but it needs to be improved. Now, with a Republican Congress, it will not be improved. One idea: I have always thought that a free-market approach to healthcare - which one part of the ACA advances but doesn't insure - would be best: make health insurance illegal for expenses up to some level (say $5000/yr) and take the tax break away for healthcare from employers. We'd pay for what we consume up to that level and that's tax deductible (healthcare accts) and everyone has to purchase catastrophic (also tax deductible but not as an employment benefit). That reduces costs (dramatically). Then the government provides direct subsidies to those who can't afford it (I get sick, I'm poor, there's a mechanism for me to get hc and have it paid for - directly - like food stamps but taking advantage of modern organizational and technological advances to create a flat, efficient system). That creates a true free mkt., takes third payers out, takes the privilege of employee provided subsidies from the few, and makes us active consumers - while providing hc for all.
M.L. Chadwick (Maine)
Todd suggests, "make health insurance illegal for expenses up to some level (say $5000/yr)... We'd pay for what we consume up to that level."

The average yearly income here in Maine is $48,453 (the national average is $53,046). In my Maine county, the average income is around $36,000.

Subtract $5000 from any of those yearly incomes. How would you and your family fare, living on what's left?

I favor single-payer national health insurance. Skip a war or two, repeal the special tax breaks for the ultra-rich, and it's feasible. The problem is, so many Americans don't grasp what life is like for our shrinking middle class. They want us to put some "skin" in the game, when we're already cutting into muscle, bone, and vital organs.
Len Charlap (Princeton, NJ)
The "free market" has never worked in health care in any country at any time. Why try it now when we know how to cut costs by more than than half. Let's do what has been proven to work.

All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year. &, especially
Bohemienne (USA)
ML Chadwick, if I recall correctly, current research by the USDA estimates the household expenditure for food is 9 percent of income. Do you really think it's unreasonable that 9 or 10 percent of income also go to heatlh care? What is more important than those two items? The cable bill? A nicer car?

I'm all for single payer but really don't get the whining of people who are willing to spend hundreds of dollars a month for internet, smartphones and television bills for their family, but kick and scream when it's suggested they spend the same amount annually to keep themselves healthy.
Hmmmmm (Nyc)
I'm glad I'm no longer able to instantaneously rack up more than $50,000 in medical bills, the way I did when I was diagnosed with cancer a few years ago. But these days, I'm facing another huge problem: every year (and I mean every year), I pay about $10,000 for medical costs (incl, insurance premiums, deductible, co-pays, co-insurance and things that aren't covered.) And that's just for me. My otherwise pretty-healthy mate pays about $6,000. If we got married, our combined costs would go up at least $6,000 a year due to the intricacies of the law and tricks of the insurance companies (that would be $22,000 annually from our combined middle-class incomes). I'm still in my 30s, by the way. So much for ever affording kids. My cancer is most likely gone for good, but my financial problems due to healthcare costs have become chronic and life-limiting.
Marathonwoman (Surry, Maine)
Experienced cancer in our family some years before the ACA, when my husband was the only insured member of our three-person family. Fortunately (?) he was the one who got it. Even with insurance, it was like acquiring a second mortgage. Took us years to dig ourselves out of that financial hole. Not to mention the added stress of financial worries to the person who is already sick. Now, thanks to Obama and the Dems, we all have affordable insurance, and don't have to hesitate about going to the doctor. It was a Godsend. And the other side offered no - NO- alternative plan. Don't tell me there's no difference between the parties!