Fewer adults delaying care, RWJF study finds
The share of adults who reported delaying or forgoing medical care because of cost declined from 12.1% in 2019 to 9.7% in 2022.
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Fewer people have been delaying care, and in 2022 the number of those forgoing medical care declined by about five million from the levels seen in 2019, according to a new study from the Robert Wood Johnson Foundation.
The share of adults who reported delaying or forgoing needed medical care because of cost declined from 12.1% in 2019 to 9.7% in 2022, the data showed.
Among adults with family incomes below 138% of the federal poverty level (FPL), researchers saw a 27% reduction in cost barriers. They saw a 19% reduction for families between 138% and 249% of the FPL, and said these two groups benefited the most from the continuous coverage requirement and enhanced Marketplace tax credits.
The largest reductions in cost-related barriers to care occurred in states that expanded Medicaid between 2019 and 2022 (from 15.7% to 10.0%), and for adults with family incomes below 138% of the FPL (from 20.3% to 14.9%) or between 138–249% of FPL (from 18.4% to 14.9%).
The overall share of uninsured adults declined from 14.5% in 2019 to 12.4% in 2022, and the share who had continuous full-year coverage increased from 82.1% to 84.4%.
Adults in states that expanded Medicaid between 2019 and 2022 experienced the largest decline in uninsurance, from 17.2% to 11%, and the largest increase in full-year coverage, from 80% to 85.8%.
WHAT'S THE IMPACT?
The findings, authors said, highlight the significant improvements in coverage and reductions in cost-related barriers to healthcare during the COVID-19 public health emergency (PHE), which were most pronounced in states that recently expanded Medicaid, and among adults with low incomes who stood to benefit most from the Medicaid continuous coverage requirement and enhanced Marketplace subsidies.
Researchers say the end of Medicaid's continuous coverage requirement and the coming expiration of enhanced Marketplace tax subsidies could make recent coverage gains difficult to sustain.
The extent to which the Medicaid continuous coverage requirement protected people from disruptions in coverage and care has important implications, authors said, as states have resumed processing Medicaid redeterminations following the policy's expiration in April 2023. Data through April of this year shows more than 20 million adults and children have been disenrolled from Medicaid during the first year of the continuous coverage requirement's unwinding, with net enrollment falling by nearly 12 million.
As states continue the unwinding, they have a variety of tools and strategies available through waivers and other mechanisms to support enrollees, such as to improve rates of ex parte, or automatic, renewals, and connect ineligible people to other coverage. Greater use of these flexibilities and extensions of flexibilities beyond the unwinding are likely needed to sustain the coverage and access gains.
THE LARGER TREND
Insurers in recent earnings reports have cited rising healthcare utilization as a reason for financial headwinds.
Cleveland Clinic physician and Qualtrics Chief Medical Officer Dr. Adrienne Boissy said in 2022 that rising costs are the top reason Americans are deferring care, especially for mental health, nutrition and preventative care.
Qualtrics data from that same year showed that nearly a third of consumers, 31%, said they deferred healthcare, and more than a quarter, 26%, chose not to fill a prescription due to cost concerns. In 2020, at the height of the pandemic, a comparable 28% deferred care due to pandemic-related concerns.
Between 2020 and 2022, the share of consumers delaying care due to COVID-19 decreased about 11 percentage points, but the percentage of those putting off care because of cost increased by four points.
Forty-six percent said the cost of healthcare services and the cost of living were the most common reasons for delaying care.
Twelve percent cited lack of medical insurance. Over a quarter (26%) of consumers in the study chose not to fill a prescription in the past 12 months because of its cost.
Fifty-nine percent of patients said they wanted their healthcare experience to mirror that of a positive retail experience. In determining their loyalty to a healthcare provider, eight in 10 patients said customer service is the second most decisive factor, after quality of care.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
