As the newly insured use their coverage, increased scrutiny is being drawn toward the experiences of consumers who are receiving care. One issue of growing concern is the accumulation of medical debt, even among the insured. According to a recent study from the Kaiser Family Foundation, more than a quarter of adults in the United States report that, within the past year, they or someone in their household have had issues with medical debt. This includes 20 percent of individuals under the age of 65 who have insurance. Also striking, 51 percent of insured individuals noting medical debt report owing sums of over $5,000, a significant sum for many households.
The issue is especially complicated as recent fluxes in the health care industry triggered by growth and shifts in coverage are occurring in tandem with experimentation by providers and insurers to reduce costs. As the industry stabilizes, it is yet to be seen what methods of controlling costs may prove most effective at lowering those costs and improving affordability for consumers.
One factor under scrutiny is the occurrence of balance or “surprise” billing which happens when patients receive a higher than expected bill from providers, even after factoring for the amount paid by a consumer’s insurer to the provider. States are also taking action to examine the issue, managing the interests of carriers, providers, and consumers to address them. This brief examines this issue, as well as state actions and legislation currently in the queue.