In the United States, the percentage of people having difficulty covering out-of-pocket healthcare costs has dropped in recent years. But a significant portion of the population still struggles to cover medical bills. According to the results of the National Health Interview Survey, sponsored by the U.S. Centers for Disease Control and Prevention (CDC), the proportion of Americans in families having trouble with medical bills dropped to 14.2 percent in 2018, down from 19.7 percent in 2011. Specifically, the share went down by 4.5 percentage points between 2011 and 2015, and then by one point from 2015 to 2018. This indicates that the decrease in the number of families with difficulties paying medical bills has slowed considerably. Still, it’s not all good news — as many of us know from watching the flurry of stories related to healthcare coverage and related legislation.

The Impact of Medical Debt

So how many Americans are currently struggling? A 2019 study from the Journal of General Internal Medicine, based on data from the 2015–2017 National Health Interview Survey, found that 137 million Americans reported experiencing financial hardship due to medical costs. Regular dental visits twice a year are crucial for patients of all ages, yet many Americans find they can’t afford this kind of preventative care or even treatment of existing medical conditions.

According to TD Ameritrade, medical debt is the number one reason why people of all ages think about dipping into their retirement accounts. But often, those accounts don’t even contain enough funds to cover medical debt. Bankruptcies in the United States increased in 2016, from 24,797 companies in the first quarter to 25,227 in the second quarter. However, business owners aren’t the only bankruptcy filers. A 2019 study published in the American Journal of Public Health found that 66.5 percent of personal bankruptcy filings stem from debt due to healthcare costs.

While 50 percent of all workers in the U.S. report having back pain every year, not everyone is equally affected by the cost of healthcare. The aforementioned CDC survey found that African American and Hispanic respondents were more likely than respondents of other races and ethnicities to report difficulties with healthcare bills. Moreover, high costs for one member of a family may impact the entire family. People who are struggling with medical debt may have difficulty paying for other necessities for themselves and their loved ones, including housing, clothing, and food. This can lead to taking money out of retirement accounts and to filing for bankruptcy.

Crowdfunding to Pay for Medical Costs

In an attempt to avoid drastic measures like bankruptcy, more people in the United States are using crowdfunding to raise money online for healthcare expenses. Crowdfunding can bring in financial support from family, friends, or even total strangers, thanks to the wonders of the internet. According to a survey conducted by the University of Chicago’s National Opinion Research Center, eight million Americans have sought help via crowdfunding on behalf of themselves or a loved one to pay for everything from routine visits to the treatment of rare conditions. In addition, over 12 million Americans report using crowdfunding to assist someone who is not a close family member with healthcare costs. Although crowdfunding campaigns don’t always raise as much as is needed, experts believe the trend is an expression of the public’s frustration with the ever-expanding costs of medical treatment. That frustration seems to be fueling people’s willingness to help others with medical bills.

How Coronavirus May Lead to Higher Medical Bills

As if Americans’ current struggles to meet healthcare costs weren’t enough, the new coronavirus, known as COVID-19, may add significantly to people’s medical bills. According to Business Insider, two Americans were recently billed over $3,000 each for coronavirus treatment, despite the fact that tests showed they’re not infected with COVID-19. Only the CDC is able to test for COVID-19 or to authorize other labs to carry out the test — and they don’t bill for testing. If someone receives treatment for coronavirus from the emergency room or an urgent care facility, they won’t be billed for COVID-19 testing, either. But patients must still pay for tests for influenza or other viruses, as well as for the visit to the facility.

Costs due to coronavirus can be considerable, whether the patient has insurance or not. Despite the expansion of coverage under the Affordable Care Act (ACA), 27 million Americans still lack health insurance — meaning they will foot the entire bill if they need to be tested or treated for COVID-19. Even those with insurance will have to contend with higher-than-expected bills from a hospital in their network, providing the doctor treating them is outside their insurance network. This is referred to as surprise billing, which affects many patients who visit the emergency room or who receive services in pathology (a department that is likely to be involved in coronavirus treatment). Problems also arise when a hospital in a patient’s insurance network is full, sending them to another hospital outside their network. In that case, the ACA’s out-of-pocket limits for in-network treatment don’t apply.

Coronavirus could even lead to more bankruptcies if it causes patients to acquire more medical debt. Unless a patient can arrange for a payment plan with a physician or hospital, bankruptcy may be the best option if they carry a lot of debt and are low income. Even for those receiving regular paychecks from steady employment, a large and unexpected healthcare bill can cause a financial crisis. And patients who are diagnosed with COVID-19 will need to be concerned with lost income if they are quarantined or are slow to recover.

The ACA has brought health insurance coverage to millions of previously uninsured Americans, yet millions more remain uninsured. What’s more, many of those with coverage still struggle with medical debts. While it’s encouraging that the percentage of families having difficulty with healthcare bills has decreased, the problem remains significant. With people turning to crowdfunding and raiding their retirement savings in order to avoid bankruptcy, and with many others using bankruptcy as their last option, it’s clear that medical costs in the United States are currently out of control.