Almost one out of four American adults, or 31 million people, were underinsured in 
2014, a study found. High deductibles or out–pocket costs made medical coverage unaffordable for many, and left others burdened by debt.
Data drawn from the Commonwealth Fund Biennial Survey found that half (51%) of underinsured adults reported problems with medical bills, and more than two five (44%) reported they avoided getting needed medical care because of cost.
More than a third (38%) either had trouble paying or couldn’t pay their medical bills and a similar portion (34%) had medical debt they were paying off over time. More than one-fifth (23%) had been contacted by a collection agency about unpaid medical bills, and a comparable number (22%) said they had to change their way life in order to pay their medical bills.
Other financial problems included 44% who received a lower credit rating, 47% who used all of their savings, 34% who took on credit card debt, 9% who took out a mortgage on their home, and 7% who declared bankruptcy.
The share working-age adults who had health insurance for all of 2014 but were underinsured was 22%, almost double the 12% reported in 2005.
Underinsured people also said they skipped needed health care, with 44% they did not go to the doctor when they were sick, did not fill a prescription, skipped a medical test, or failed to see a specialist when their doctor told them to do so.
Although people buying their own are more likely to be underinsured than those with employer coverage (37% vs. 20%), the share of people with employer insurance who are underinsured has doubled since 2003, when it was 10%. The report found underinsured rates are higher among those working in small firms, with 27% underinsured compared to 14% in firms with 100 or more workers.
The authors of the study said they could not separately assess the effects of the Affordable Care Act on underinsurance because many of the people insured throughout 2014 had coverage that began prior to major expansion of the law’s effect.
