Paying for It: The Costs of Debt Leave Americans Sicker and Poorer


In 2023, the Commonwealth Fund conducted an extensive survey shedding light on the financial burdens that many Americans face when it comes to healthcare expenses. The report, titled “Paying for It: The Costs of Debt Leave Americans Sicker and Poorer – 2023 Affordability Survey,” (released October 2023) reveals the stark reality of healthcare affordability in the United States. In this blog post, we’ll provide a summary of the key findings and implications of this survey.

Half of working-age adults said it was very or somewhat difficult to afford their health care costs.

The Burden of Healthcare Costs

One of the most significant findings of the 2023 Affordability Survey is that a substantial portion of the American population is struggling to afford necessary healthcare. Even with insurance, a significant number of respondents reported that they had to make difficult choices due to healthcare costs, including delaying or skipping needed care.

  1. Medical Debt Is a Widespread Problem: The survey highlights that medical debt remains a pervasive issue in the United States. A staggering number of respondents reported carrying medical debt, which can have detrimental effects on their financial stability and overall well-being.
  2. Affordability Barriers to Care: A substantial percentage of respondents faced affordability barriers when accessing healthcare services. These barriers include the cost of premiums, deductibles, and out-of-pocket expenses, which can often deter individuals from seeking necessary care.
  3. Delayed and Forgone Care: A concerning trend revealed by the survey is that many Employees are postponing or forgoing essential medical treatments due to financial constraints. Delayed care can lead to worsened health outcomes and higher treatment costs in the long run.

More than half of working-age adults who said they delayed or skipped care because of costs said a health problem got worse as a result.

Impact on Employees’ Lives

The financial strain caused by healthcare expenses can have far-reaching consequences on Employees’ lives, both physically and economically.

  1. Health Outcomes: The inability to access timely healthcare can result in deteriorating health conditions and even preventable complications. When people can’t afford the care they need, their overall health and well-being suffer.
  2. Economic Consequences: Medical debt can quickly spiral out of control, leading to financial instability and a cycle of debt that is challenging to escape. This can have implications for individuals’ credit scores, employment, and quality of life.
  3. Mental Health: The stress and anxiety caused by healthcare-related financial burdens can take a toll on individuals’ mental health. Worrying about how to pay for medical bills can lead to increased stress and decreased overall life satisfaction.

Nearly one-third of working-age adults reported having medical or dental debt they were paying off over time.

Policy Implications

The 2023 Affordability Survey underscores the urgent need for policy changes to address healthcare affordability in the United States.

  1. Improved Access: Expanding access to healthcare and addressing out-of-pocket costs is crucial in ensuring that individuals can obtain necessary care without incurring significant financial burdens.  
  2. Price Transparency: Implementing measures to increase price transparency in the healthcare industry can help individuals make informed decisions about their care and potentially reduce costs.
  3. Debt Relief & Management: Policymakers should consider options for alleviating medical debt, such as debt forgiveness programs or improved bankruptcy protections.  Employers should consider options to help Employees avoid going into debt or making other costly choices when accessing care.
  4. Promoting Preventive Care: Encouraging regular check-ups and preventive care can help prevent more expensive and complex health issues down the road.

About one-third of working-age adults said health care costs made it harder for them to afford other living expenses.


The 2023 Affordability Survey by the Commonwealth Fund provides a sobering look at the challenges many Employees face in affording – and accessing – healthcare. The findings underscore the urgent need for employers to ensure that individuals can access the care they need without suffering the financial and health consequences of medical debt and affordability barriers. Addressing these issues is essential to creating a healthier and more economically stable future for all Employees.

Access the full Commonwealth Fund 2023 Affordability Survey here.

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