An analysis by the National Center for Health Statistics (NCHS), an agency of the Centers for Disease Control and Prevention, shows that the number of Americans experiencing problems paying their medical bills fell between 2011 and mid-2014. 

The proportion of the population under age 65 having trouble paying dropped from 21.3% (or 56.5 million) in 2011 to 17.8% (47.7 million) in mid-2014. The analysis, based on data from the National Health Interview Survey, partially echoed a Commonwealth Fund survey that found the number of people reporting medical debt problems dropped in 2014 for the first time in 10 years.

Additional findings from the NHIS include:

  • In the first six months of 2014, among people under age 65, 31.2% of those who were uninsured, 24.2% of those who had public coverage and 12.4% of those who had private coverage were in families having problems paying medical bills in the past 12 months.
  • The percentage of children ages 0-17 years who were in families having problems paying medical bills decreased from 23.2% in 2011 to 19% in the first six months of 2014.
  • Within each year, from 2011 through June 2014, children aged 0-17 years were more likely than adults aged 18-64 to be in families having problems paying medical bills.

The NCHS analysis found that during the first half of 2014 - when the Affordable Care Act’s coverage provisions went into effect - the share of uninsured dropped and the share of privately insured increased. But the share of publicly insured people changed little, despite the addition of millions of people to Medicaid roles during that period as authorized by the Act. 
The decline in unaffordable healthcare costs also seemed to run counter to the trend in Affordable Care Act marketplaces, which are dominated by high-deductible health insurance plans. In those government-operated marketplaces, the average out-of-pocket maximum for 2015 silver plans - used by 70% of enrollees - was $5,853, according to an analysis by healthcare consultancy Avalere Health.

Regardless of conflicts with other data, the NCHS-reported trend coincides with increasing efforts by hospitals and physicians "to reach out in new and different ways to patients to provide patient-friendly approaches to resolving medical bills," said Todd Nelson, director of healthcare finance policy, operational initiatives, for the Healthcare Financial Management Association (HFMA).

For example, in January 2014 an HFMA-led task force released recommended industry guidelines and a patient education framework related to medical debt. HFMA also launched its Healthcare Dollars & Sense initiative , which included ways consumers should be informed in advance about certain actions to collect an unpaid bill.

The findings come as federal regulators seek to increase their oversight of medical debt issues. A December report on medical debt, issued by the Consumer Financial Protection Bureau, found that one out of five credit reports contains medical debt in collections. For 15 million people, medical debt is the only debt they have in collections in their credit report.

Also in December, the CFPB also reported that an estimated 43 million Americans carry delinquent medical debt on their credit reports and medical bills account for about half, or 52%, of all overdue debt appearing on reports, according to a study. 

The CFPB announced along with the report that major credit reporting agencies - including Experian, Equifax and TransUnion - will be required under new reporting rules to list any complaints they receive about the accuracy of consumers' credit reports. The information should help the CFPB identify the types of debts that are more likely to be reported erroneously.

Last year, Fair Isaac Corporation (FICO) started using a new scoring model that changes the way medical debt is weighted and no longer factors in overdue payments that have since been made.  

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