The Illusion of Coverage: How Health Insurance Fails People When They Get Sick

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Abstract:

Recent research has clearly documented that unaffordable medical bills and resulting medical debt are widespread in the United States. Although the uninsured are most at risk, people with insurance are vulnerable as well; one survey found that more than one quarter of people continuously insured over the previous year had medical bill problems or medical debt. However, while national surveys document the prevalence of medical bill problems among the insured, they are not able to demonstrate the specific ways in which health insurance products fail to protect people financially and fail to guarantee their access to needed care when ill or injured.
The purpose of this study is to investigate the gaps in coverage and the systemic problems that cause insured people to accrue medical debt, as well as the consequences of the debt for individuals and families. The findings are based on in-depth interviews with 45 people in seven states who had accrued medical debt while they were privately insured, either through an employer sponsored or an individually purchased plan.

The findings are summarized below. However, because summary findings cannot easily convey the complexity of our interviewees’ experiences, we recommend that all readers also review the stories and comments in the body of the report. To facilitate this process, we have highlighted some of the stories and comments within the text.