Two Urban Institute reports funded by the Robert Wood Johnson Foundation found that 9.4 million fewer families struggled to pay medical bills in early 2015 than just before the rollout of public exchanges and Medicaid expansion in 2013. The extent to which these findings were driven by coverage gains, an improving economy or other factors remains unknown.

“It’s encouraging to see that fewer families report problems with medical bills, but at the same time it’s very clear that health insurance does not provide immunity from financial distress,” according to Katherine Hempstead, who directs the Robert Wood Johnson Foundation’s work on health insurance coverage. “Affordability remains our biggest health care challenge – affecting both enrollment in coverage as well as access to care for those who are covered.”

However, financial challenges persist mostly among low-income earners, the uninsured, high-deductible health plan participants or those in fair or poor health. As many as 73.8% of those who reported problems paying their medical bills in March 2015 went without at least one of seven types of health care services over the previous year. In addition, 24.5% of all nonelderly adults are still paying off medical debts related to premiums, deductibles, copayments, coinsurance, or uncovered services. Most of those unpaid bills (70.3%) were incurred when they or their family member had health insurance.

Other key findings show a decline in nonelderly adults who struggle to pay medical bills to 17.3% in March 2015 from 22% in September 2013, but also an increase among those who were uninsured for part or all of 2014 to 25.1% from 15.1% who were insured throughout 2013.

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