Rising Health Costs Push Insured Americans to Delay Care and Take on Debt

Health coverage no longer guarantees that care is affordable. Across the United States, people with insurance are putting off appointments, reducing medication use and borrowing to cover bills. People without coverage face the risk of medical costs that can quickly exceed what a household can pay. The accounts gathered by KFF Health News show how those pressures reach beyond people with low incomes or no insurance: chronic illness, a high deductible or a sudden medical emergency can strain families who thought they were prepared.

The reporting includes stories from more than 130 people in different parts of the country. Their experiences come amid rapid growth in health spending and higher premiums and out-of-pocket costs. These individual accounts illustrate the consequences for patients; they do not, by themselves, measure how common each experience is. But the wider spending figures point to a system where prices and the amount of care people receive have both contributed to rising costs.

Coverage can still leave large bills

Bill McAdams, a 45-year-old travel nurse in Holiday, Florida, was uninsured when he had a stroke last year. The health plan offered through his agency would have cost $3,600 a month to cover him and his wife, which he couldn’t afford. The hospital initially billed him $93,000.

McAdams later bought insurance, but said the plan did not cover preexisting conditions. In March, he had problems with his vision and balance. Afraid of another large bill, he went to an urgent care center instead of an emergency room. After speaking with the hospital about the earlier stroke bill later that month, he experienced problems again and went to the emergency room with a second stroke. He believes stress over the bill contributed to that event; his account doesn’t establish that the financial stress caused it.

The hospital eventually reduced his total bill to $50,436, still more than he could manage without a steady salary. He is applying for disability benefits because he can no longer work as a nurse, and he and his wife are expecting a baby. His experience captures a difficult bind: fear of the cost can delay care, while delaying care can leave a person facing a more serious health problem.

Insurance also hasn’t shielded Janet Marx, 56, of Milford, Connecticut, from the financial consequences of chronic illness. She has lupus and fibromyalgia, receives disability income and is covered by both Medicare and her husband’s employer plan. Even with that coverage, a series of $80 copayments for in-home physical therapy helped prompt her and her husband to sell the home where she grew up and move into an apartment.

Sheila Robinson, 61, of District Heights, Maryland, has a $10,000 deductible on her marketplace plan. She pays a $659 monthly premium by credit card and tries to negotiate lower self-pay prices when she visits a doctor. She says she’s afraid to seek care for arthritis, a pinched nerve in her neck and high blood pressure because she’s already struggling to meet her expenses.

Damien Waikoloa, a 35-year-old small-business owner in Honolulu, chose to keep coverage while managing several chronic conditions. His monthly premium rose to more than $400, from about $240 the previous year. To keep paying it, he is cutting business expenses, considering a reduction in his own pay and spending less on meals out and trips to see family and friends. He says plans such as saving for a home or starting a family have been pushed aside.

Health spending and prices keep climbing

U.S. health spending reached nearly $5.3 trillion in 2024, up from $3 trillion a decade earlier, according to national expenditure data. Health spending grew at its fastest rates in two decades in 2023 and 2024, excluding the pandemic-related surge in 2020. It has outpaced growth in the broader economy for decades, and projections suggest it could reach 20% of the nation’s economic output by 2032, up from just under 19% today.

A typical American family spends about $5,600 a year, or 9% of its income, on premiums, out-of-pocket care and taxes that fund health programs, according to the Peterson-KFF Health System Tracker. At the national level, annual health spending works out to more than $15,400 per person. Those figures describe different measures: the family estimate reflects household costs and taxes, while the per-person figure reflects total spending across the health system.

Prices are a major part of the explanation. U.S. clinicians perform about a third as many inpatient knee replacements as clinicians in other wealthy countries, yet the price per procedure is higher than in most of those nations. The comparison suggests that high spending isn’t simply a result of Americans receiving more of every kind of care.

Researchers point to several pressures behind recent price growth. Hospital mergers can give health systems greater bargaining power to charge insurers more. New treatments and technologies, including GLP-1 medicines used for diabetes and weight loss, can carry high prices. Inflation and tariffs add costs for supplies and devices. When more people lack insurance, the costs of care may also fall more heavily on those who remain insured or pay out of pocket.

The structure of the U.S. system adds another layer. Prices are generally negotiated between insurers and hospitals, clinicians and drug companies rather than set centrally. More than half of health payments were tied to fee-for-service arrangements in 2022, under which providers are paid for each service, test or treatment. That model can reward more billable care without ensuring that each extra service improves a patient’s health.

Administrative complexity also costs money. Different insurers, networks, payment rates and billing systems require extensive paperwork and billing work; estimates put administrative waste in the hundreds of billions of dollars. Insurers try to control spending by limiting what they reimburse, while also retaining a share of payments. As Brown University health policy researcher Christopher Whaley put it, financial incentives are spread throughout the system.

Higher prices don’t reliably translate into better care, said Steven Ullmann, a University of Miami health policy professor. He described wide differences in prices for prenatal ultrasounds in Orlando without an obvious difference in quality. He also argued that the system can favor expensive treatment over lower-cost preventive care and steer people toward clinicians in their network, whether or not those choices lead to better outcomes.

Medical bills can disrupt work and treatment

Carmilla Collins, 52, of Omaha, Nebraska, faced wage garnishment after a hospital pursued unpaid bills she had accumulated while insured and uninsured. A single mother, she said she hadn’t questioned tests or medicines recommended after her thyroid disease diagnosis, or routine procedures such as a colonoscopy, until the bills became debt. A collection agency sued her, and money was taken from her paycheck. She nearly fell behind on rent while working two jobs.

Collins eventually qualified for hospital financial assistance. Before then, she delayed thyroid surgery for four months, worried about paying her deductible and other costs. Her goiter grew and made it difficult to eat. She said her health worsened until she felt she couldn’t put off surgery any longer. Her story shows how financial barriers can remain even for someone with employer coverage, and how debt can become part of the decision about when to seek treatment.

Lynn Ludaway, 40, of Evanston, Illinois, was diagnosed with multiple sclerosis in 2023. She and her husband had employer coverage, but medical bills still reached tens of thousands of dollars. As her mobility declined, she also had expenses for transportation and a cane. She gave up her consulting business and used savings and retirement funds to pay for tests and treatment.

Ludaway now pays $500 a month for a marketplace plan, but her household income makes her ineligible for state or federal assistance. She relies on charitable programs and aid from the hospital where she receives care, and goes without dental and mental health care she says she cannot afford. She described needing rest to recover while also needing to work to pay her bills.

Shayna Sanders, a 45-year-old marriage and family therapist in New Haven, Connecticut, has bought marketplace insurance for more than a decade. Her monthly premiums have risen to close to $1,000. Insurance helps her earn a living by covering appointments with her patients, but she says some plans are now too expensive for her to afford for herself.

When premiums rise, some people drop coverage

Melody Stephens, 55, of Berryville, Arkansas, dropped her marketplace coverage after the monthly premium for her and her younger daughter rose from just over $200 to more than $2,000. She also couldn’t afford the $1,000 monthly premium for her employer plan. Stephens is a cancer survivor and a nurse in an assisted-living facility; she had first enrolled in a marketplace plan after being diagnosed with anal cancer about a decade ago.

Even while insured, Stephens filed for bankruptcy two years ago. Her plan covered much of her cancer care, but she faced substantial costs for treating radiation side effects. Now uninsured, she and her daughter depend on financial help and have bills remaining for tests and treatment, including after her daughter’s surgeries.

Stephens says she stopped taking a GLP-1 medicine prescribed for diabetes and a medicine for nerve pain because of the cost. She also says she can’t afford a colostomy and lives with incontinence. These are her reported circumstances, not evidence that the same costs or options apply to other patients. They do show how losing coverage can coincide with difficult choices about ongoing care.

KFF estimates that about 27 million people under age 65—nearly one in 10 in that age group—were uninsured in 2024. Its account of a nonpartisan budget office projection says policy and funding changes could add 10 million or more people to that number by 2034. Those estimates are projections, not a count of people who have already lost coverage.

Who pays can change, while costs remain

Many proposals in the current debate would shift health costs among patients, employers and taxpayers. Subsidies can reduce the amount some people pay directly for marketplace coverage, while placing more of the expense on public budgets. Reductions in public support can move more of the bill to patients and may leave more people uninsured. Neither approach, by itself, guarantees lower prices for care.

A single public insurer could reduce patients’ out-of-pocket spending, depending on how it was designed, while leaving the underlying prices charged by providers and drugmakers high. Price transparency requirements have also had little effect so far. Harvard health policy professor Michael Chernew argues that discussions about access and quality need to address the growth in total spending, as costs are paid collectively through some combination of premiums, taxes and direct bills.

There are strong obstacles to reducing spending. Lower payments would mean less income for hospitals, clinicians, drugmakers, insurers or other parts of the system. Yale health economist Zack Cooper summarized the tension: health spending for one party is income for another. Administrative changes or price caps, used in some other countries, have also faced resistance in the United States. The health sector has spent more than $14 billion lobbying national legislators since 1998, according to OpenSecrets.

Some efforts to limit prices have emerged in places where they might once have seemed less likely. Indiana set limits on what some nonprofit hospitals can charge patients with employer coverage; five large nonprofit hospitals could lose their tax-exempt status starting in 2029 if their prices exceed those limits. Texas Gov. Greg Abbott has proposed limits on certain drug prices. The source also reports efforts by two successive administrations to reduce prescription drug prices, following consumer pressure. Drug prices recorded their steepest drop in decades this year, offering some relief even as other costs rise.

Pressure is building for patients and employers

Insurers say marketplace premiums are expected to rise 15% next year, the second consecutive year of double-digit increases. Employer health costs are projected to grow 9.5% in 2027, a rise that may put further pressure on workers. Forecasts can change, but they point to continued strain for people whose wages and household budgets must absorb higher premiums and care costs.

Healthcare affordability ranks among the public’s leading concerns, according to a KFF poll conducted in mid-September. Nine in 10 Democratic respondents and three-quarters of Republican respondents said the U.S. health system needs a complete overhaul or major changes. These views reflect dissatisfaction across party groups, while the poll does not establish what specific changes respondents would support.

The consequences are visible in the choices people describe: Robinson putting off doctor visits, Marx selling a home, Waikoloa cutting spending, Ludaway forgoing dental and mental health care, and Stephens stopping medicines. McAdams’s experience is a particularly stark example of how fear of a bill can shape decisions during a health emergency. His account cannot establish that the billing dispute caused his second stroke, but his reluctance to go to the emergency room shows how financial concerns can affect when people seek help.

There is no simple fix, and a reduction in one person’s bill may shift costs elsewhere unless the prices and incentives that drive spending also change. For households, a practical first step when a bill or coverage cost feels unmanageable may be to ask a health plan, care provider or pharmacist what financial assistance, lower-cost alternatives or payment arrangements are available. People who are weighing delayed care or a change in medication can discuss the health and cost implications with a clinician or pharmacist. The larger question remains whether future efforts can slow the prices behind rising bills while preserving access to needed care.