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.”

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