Coronavirus Pandemic Policies May Have Improved Care Affordability

Coronavirus pandemic policies may have helped curb unmet care, unaffordability in care, and certain care disparities, but these trends could also reflect lower overall care utilization due to healthcare shutdowns during the pandemic, according to a Robert Wood Johnson Foundation report.

The researchers used the Urban Institute’s annual Well-Being and Basic Needs Survey (WBNS) from 2017 to 2022, with around 7,500 KnowledgePanel participants between the ages of 18 and 64 each year. The survey was offered in English and Spanish, and the results reflect both households with and without internet access.

“Improvements in affordability between 2019 and 2022 emerged after temporary new policies protected and expanded access to public or subsidized coverage,” the researchers found. “Pandemic-era changes in the health insurance policy landscape have expired or are scheduled to expire in the coming years, however, which may halt recent progress in making health care more affordable.”

The results showed that healthcare affordability improved during the timeframe of the pandemic. After two years without much progress, the share of adults struggling to pay family medical bills and foregoing care dropped.

In December 2019, 18.7 percent of adults reported having trouble paying off medical bills in the past year. By December 2022, this share had dropped to 15.0 percent. Similarly, a smaller population of adults reported foregoing care due to affordability. Whereas 18.5 percent of adults reported using this strategy in 2019, 13.9 percent reported the same in 2022.

Low-income families saw a decrease in unmet needs. For individuals with incomes below 100 percent of the federal poverty level (FPL), the share of individuals with unmet care needs dropped from 27.2 percent to 18.8 percent.

For adults with incomes between 100 and 200 percent of FPL, challenges paying family medical bills declined from plaguing 32.4 percent of the population in 2019 to 24.9 percent in 2022. Individuals in this income bracket also saw a decrease in unmet care needs, with the share of this population experiencing unmet needs dropping from 31.9 percent to 24.1 percent.

Higher-income families also saw healthcare affordability improve. Reports of challenges paying medical bills dropped from 10.1 percent to 6.1 percent, and reports of unmet care needs declined from 9.3 percent to 6.3 percent for adults with incomes of 400 percent of FPL or more.

While the coronavirus pandemic deepened care disparities in certain metrics, minority and underserved populations saw better health equity in healthcare affordability during this timeframe. Black and Hispanic adults were less likely to report issues of paying family medical bills or foregoing care, reducing the gap between them and White adults.

For example, in 2019, 22.7 percent of Hispanic adults had trouble paying family medical bills. By 2022, 17.0 percent of the population struggled with this.

In 2019, Black adults were more likely than White adults to report issues paying medical bills by 7.4 percentage points. Nearly a quarter of Black adults at the time reported this challenge. By 2022, however, the rates of adults who had trouble paying medical bills were almost equal between Black and White Americans (15.9 percent and 14.2 percent, respectively).

The researchers attributed these gains to policies that stopped Medicaid disenrollment and federal relief benefits. However, the gains could also reflect the fact that adults stopped utilizing care as frequently during the pandemic. Federal and state actions to extend these policies or improve the existing policies could help continue the positive trends.

“The relative importance of different policies and factors in explaining recent improvements in health care affordability is unknown, but the reduction in uninsurance during the COVID-19 pandemic suggests that policies protecting insurance coverage can mitigate the impact of future economic downturns or public health crises,” the report concluded.