Black, Hispanic and low-income Americans were disproportionately affected by medical bill and debt problems during the pandemic, according to a survey by the Commonwealth Fund, a private, nonpartisan foundation.

Of the 5,450 adults aged 19 to 64 years old who were surveyed, 38% struggled to pay medical bills over the past year. This finding was similar to surveys conducted in 2018 and 2020, the New York-based foundation noted.

While 32% of white respondents said they were affected, that proportion rose to 55% of Black respondents and 44% of Latino/Hispanic respondents.

Lower-income respondents to the survey — which was conducted March 9 to June 8 — were also disproportionately impacted during the pandemic, with 47% of those on less than 250% of the federal poverty level experiencing bill or debt problems compared to 31% of those above this level. The federal poverty level in the 48 contiguous states and the District of Columbia is an annual income of $12,880 or less for an individual and $26,500 for a family of four, according to the U.S. Department of Health and Human Services.

The survey findings illuminate the effects of a surge in unemployment and government relief responses on healthcare coverage and affordability in the year after pandemic control measures took hold.

For those affected, the financial burden of medical care often led to other issues, with 35% having used up all or most of their savings and 27% unable to pay for basic necessities like food, heat and rent, the survey found.

One-third of all adults had seen their income fall over the past year, affecting 27% of white respondents, 44% of Black respondents and 45% of Hispanic/Latino respondents.

When it came to insurance coverage, 7% of white respondents were uninsured, compared to 11% of Black respondents and 20% of Latino/Hispanic respondents.

Adult Medicaid enrollment climbed by 6.3 million people between February 2020 and January 2021, which the Commonwealth Fund attributed in part to the March 2020 Families First Coronavirus Response Act — which prevented participating states from disenrolling people from the health insurance program during the public health emergency — as well as statewide special enrollment periods and increased marketplace subsidies.

These findings echoed a June 17 Kaiser Family Foundation analysis of data from the U.S. Centers for Medicare and Medicaid Services, which showed total Medicaid and Children's Health Insurance Program enrollment increased by 9.3 million between February 2020 and January 2021.

Pandemic-related coverage losses were relatively small, the Commonwealth Fund authors pointed out in their July 16 report based on the survey results. Of the 6% who lost employer-related coverage at some point, 67% gained coverage elsewhere.

"The survey findings ... suggest that federal relief efforts to help people maintain their Medicaid coverage, combined with state and federal efforts to encourage people to enroll in the [Affordable Care Act] marketplaces and in Medicaid, may have offset pandemic-related, job-based coverage losses," the report's authors wrote.

"But the findings also show that large shares of adults continue to suffer financially when they get healthcare, even if they are covered by Medicare, Medicaid or private insurance," they added.

Searching for solutions

In addition to the No Surprises Act — which will make it illegal starting in 2022 for providers to bill patients for more than the in-network cost-sharing due under patients' insurance in almost all scenarios — the report's authors recommended policies to protect more consumers.

These included potentially reducing the number of uninsured by 4.2 million by making the temporary American Rescue Plan marketplace subsidies permanent and providing a federal insurance option to Medicaid-eligible adults in the 13 states that have not yet expanded their program, which would itself cover an estimated 2.3 million currently uninsured people.

Other options to make medical coverage more comprehensive ranged from reining in deductibles and out-of-pocket costs in Affordable Care Act marketplace plans to standardizing health plans and investigating the increasing reports of coverage denials.

"Even before the pandemic, people were struggling with inadequate health coverage and mounting medical debt," Commonwealth Fund President David Blumenthal said. "Now, the administration and Congress have an opportunity to ensure not only that all U.S. residents have health insurance but that the coverage is affordable and comprehensive."