Medical Bankruptcy: Still Common Despite the Affordable Care Act

• Published in: American journal of public health (1971) Vol. 109; no. 3; pp. 431 - 433
• Main Authors: Himmelstein, David U, Lawless, Robert M, Thorne, Deborah, Foohey, Pamela, Woolhandler, Steffie
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01.03.2019
• Subjects: Accounting; Adult; Aged; Aged, 80 and over; AJPH Law & Ethics; Bankruptcy; Bankruptcy - economics; Bankruptcy - statistics & numerical data; Debt; Delivery of Health Care - economics; Delivery of Health Care - legislation & jurisprudence; Economics, Medical - statistics & numerical data; Female; Health care access; Health care expenditures; Health care industry; Health insurance; Health Policy; Health Reform; Hospitalization; Humans; Illnesses; Insurance; Insurance coverage; Insurance policies; Linearization; Male; Medicaid; Middle Aged; Nobel prizes; Other Health Financing; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act; Polls & surveys; Public health; Response rates; Trends; Uninsured people; United States; United States; United States > US
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2018.304901

Myriad anecdotes—of a Nobel laureate who sold his medal to pay medical bills, or the more than 250 000 GoFundMe medical campaigns last year —attest to the financial toll of illness on American families. National surveys confirm that medical bills frequently cause financial hardship, and the US Consumer Financial Protection Bureau reported that they were by far the most common cause of unpaid bills sent to collection agencies in 2014, accounting for more than half of all such debts. Less evidence is available on the medical causes of bankruptcy, a public and stigmatizing confession of impoverishment. In surveys conducted by researchers with the Consumer Bankruptcy Project in 2001 and 2007, a majority of recently bankrupt debtors implicated medical bills or illness-related work loss as causes of their bankruptcy, findings that President Obama used to argue for passage of the Affordable Care Act (ACA). The ACA both expanded and upgraded health insurance coverage, banning preexisting illness exclusions, imposing a cap on out-of-pocket spending, and mandating coverage for essential benefits. Although these reforms might attenuate the risk of medical bankruptcy, increasing medical costs and stagnant incomes could have the opposite effect.