Privately Insured in America: Opinions on Health Care Costs and Coverage

With funding from the Robert Wood Johnson Foundation, the Associated Press-NORC Center for Public Affairs Research conducted a national survey of 1,004 adults age 18-64 with private health insurance.

A new, nationally representative survey, conducted by the Associated Press-NORC Center for Public Affairs Research, with funding from the Robert Wood Johnson Foundation, shows that most, but not all, privately insured Americans age 18-64 are satisfied with their health plans, are not deterred from using their health benefits due to cost, and say health care costs do not have a large impact on their finances. However, a significant minority of those with private health insurance, including those covered by high-deductible health plans (HDHPs), are greatly impacted by the out-of-pocket cost of health care—they are concerned with the uncertainty of major expenses, skip necessary medical treatment, and experience real financial burden when obtaining health care. All told, about 1 in 8 privately insured Americans—or more than 16 million people—face major financial hardships like going without food or using up all of their savings as a result of medical bills. 

As more provisions of the Affordable Care Act (ACA) are implemented over the next decade, the government projects that approximately 12 million additional people younger than 65 will enter the private insurance market. This survey provides new and actionable data about the opinions of private insurance consumers during this moment of profound reform to the health insurance market. As both the private market and the government seek ways to control health care costs, these data reveal important insights for policy-makers, health care plans, and purchasers and provide an understanding of privately insured individuals’ views on the price of health care, how health costs impact their health care utilization decisions, and the extent to which other aspects of their lives are affected by health care costs.

The AP-NORC Center conducted interviews with 1,004 privately insured adults age 18-64, including 267 who report having a high-deductible health plan.  

Five Things You Should Know

From the AP-NORC Center’s Cost and Coverage Poll

Among adults 64 and under with private health insurance:

  • A quarter worry about the financial consequences of a major unexpected medical expense such as a surgery or life threatening illness.
  • Nearly 20 percent don’t go to the doctor when they are sick because they worry about the cost of health care, even though they have insurance.
  • Those with high-deductible health care plans are especially likely to worry about the impacts of health care costs on personal finances and to think about costs when making health care decisions.
  • Most privately insured Americans have experience changing health care plans. After changing plans, 41 percent say their costs went up, but only 18 percent of them think they are getting higher-quality care in exchange for those higher costs.
  • Fifty-two percent say they’d rather pay higher premiums in exchange for limiting their out-of-pocket costs, and 40 percent would prefer to trade lower premiums for higher out-of-pocket costs.