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THURSDAY, Feb. 26, 2015 (HealthDay News) -- The number of Americans struggling to pay medical bills has declined every year since 2011 and particularly since 2013, a new government report shows.
Health policy and medical bill experts believe the new patient protections and coverage offered under the Affordable Care Act, as well as the steadily improving national economy, may have contributed to families' financial relief.
A less positive possibility is that some families in "high-deductible" health plans may be holding off on using medical services, experts added.
In 2011, 56.5 million people under the age of 65 were in families that had problems paying medical bills in the previous 12 months. But that dropped to just under 48 million people in the first half of 2014, according to the U.S. National Center for Health Statistics (NCHS), part of the U.S. Centers for Disease Control and Prevention.
"So we're seeing almost 9 million fewer people in that age group who are in families having problems payment medical bills," said Robin Cohen, an NCHS statistician and the report's author.
NCHS examined people with bill-paying problems by age, gender, race and ethnicity, insurance status and economic status. In every year since 2011, each demographic group experienced year-over-year relief from all types of medical bills, including doctor and hospital charges.
"To me, it's just kind of like a 'Wow,' " said Lynn Blewett, a professor of health policy and management at the University of Minnesota School of Public Health.
Since 2011, the proportion of children and adults under age 65 in families strained by medical expenses has declined by 3.5 percentage points. A good chunk of that improvement -- nearly 2 percentage points -- occurred between 2013 and the first half of 2014, when the number of people reporting medical bill-paying problems dropped by more than 4 million.
"It's a precipitous drop," Cohen observed.
Even though the latest numbers are based on just six months of data, the 2014 numbers are valid and provide an apples-to-apples comparison with 2013 data, she said.
NCHS began asking Americans about their medical bill-paying difficulties in 2011. The report provides early estimates of the problem based on household surveys involving more than 370,000 people.
Blewett said the improvement in bill-paying concerns may reflect, among other factors, a reduction in uninsured Americans and an increase in people with coverage through programs like Medicaid and the state Children's Health Insurance Program.
The number of uninsured Americans under age 65 fell to almost 41 million in the first quarter of 2014, from slightly more than 44 million in 2013. And the numbers have tumbled steadily since 2010, the year President Barack Obama signed the Affordable Care Act (ACA) into law, according to CDC data.
Health policy experts say early gains in health insurance are due in part to the extension of coverage to young adults under their parents' health insurance plans, and the expansion of Medicaid eligibility rules in some states. Each of these policy changes were part of the ACA, sometimes referred to as Obamacare.
The landmark law's expansion of private health plans through federal and state marketplaces began in October 2013, for 2014 insurance coverage.
But many people waited until February or later to sign up, said David Warner, a health and social policy professor at the University of Texas at Austin.
Warner doesn't believe sign-ups through the new ACA health insurance marketplaces are reflected in the NCHS report, since coverage would not have kicked in for the vast majority of medical bills people incurred over the previous year.
However, some of the earlier implemented ACA initiatives, such as guaranteed coverage for children regardless of pre-existing conditions, may have contributed to the trend the report found, he said.
And it may be that more people are qualifying for financial help under hospitals' financial assistance policies, reasoned Mark Chapman, owner of Chapman Consulting L.L.C., based in Austin, Texas, which negotiates hospital and medical bills for consumers.
The ACA requires not-for-profit hospitals to tell patients about their financial assistance programs and how to apply for help before attempting to collect on a patient's bill.
Even some for-profit hospitals are reducing rates paid by uninsured patients to what they would have charged insurance companies, Chapman added.
Experts also noted a possible darker side to the reduction in medical bill-paying problems. Since a growing number of Americans are enrolled in high-deductible health plans, some people may be forgoing care. As a result, they're not piling up medical bills.
Chapman said he's not fielding as many calls from patients who are totally uninsured, but he is hearing from people who are discovering, "Oh my gosh, I've got a $10,000 deductible or a $5,000 deductible." And in those cases, he says there's nothing he can do to help them.
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SOURCES: Robin Cohen, Ph.D., statistician, U.S. National Center for Health Statistics, Hyatttsville, Md.; Lynn Blewett, Ph.D., professor, health policy and management, University of Minnesota School of Public Health, Minneapolis, Minn.; David Warner, Ph.D., health and social policy professor, University of Texas at Austin; Mark Chapman, owner, Chapman Consulting L.L.C., Austin, Texas; U.S. National Center for Health Statistics, report