U.S. healthcare system leaves far too many people underinsured

Amy Finkelstein, co-scientific director of the Abdul Latif Jameel Poverty Action Lab (J-PAL) North America, speaks about the American healthcare system at the STAT Summit in Boston, promoting the need for automatic enrolment as a foundational step towards universal access to essential services.


Universal health care access remains an unrealistic dream for America. Addressing the problem of lack of (adequate) health insurance for many Americans will involve a huge undertaking, but it is necessary to ensure that everyone has at least a basic level of insured care.

According to the Commonwealth Fund report released last year, the number of underinsured people in America is increasing. In 2022, 43% of working-age adults were inadequately insured. These are individuals who were uninsured (9%), had gaps in coverage (11%) or were insured all year but had coverage that did not provide them affordable access to health care (23%). This means that many people who technically have health insurance still have to bear high out-of-pocket costs, including the cost of prescription drugs. According to KFF, nearly 50% of Americans say it is “difficult to afford health care,” with nearly 25% saying they or a family member had trouble paying for health care during the past year.

So millions of Americans are in a vulnerable position at any time during the year. The uncertainty of a health care system in which unregulated coverage is so widespread means that many people have the proverbial sword of Damocles hanging over their heads. About one in five American families has medical debt, meaning they were unable to pay the medical bills when they received care. Among households with medical debt, the average amount owed is approximately $2,000. Households without adequate insurance have nearly twice as much medical debt as households with coverage. And according to a recent study published in the American Journal of Public Health, about 530,000 people reported falling into bankruptcy. Per year Resulting in medical bills.