A new Commonwealth Fund survey finds that one in three privately insured Americans are carrying medical debt, a burden that is draining savings, forcing families to skip meals, and pushing patients to delay the care they already pay premiums to receive.
The nonpartisan health policy research group published its findings Thursday, drawing on a nationally representative telephone and online survey of 6,353 adults. The headline number is stark: roughly a third of working-age Americans who hold employer-sponsored, Affordable Care Act marketplace, or other private coverage report medical debt they are paying off over time. Nearly two-thirds of those carrying that debt trace it to hospital visits. Others owe money for routine care, doctor's office visits, lab work, and diagnostic tests that most people assume their insurance handles.
The problem is not that these Americans skipped buying coverage. They bought it, kept paying premiums, and still ended up underwater when the bills arrived. That gap between what insurance promises and what it actually covers sits at the center of the report, and it raises a straightforward question: what exactly are tens of millions of families getting for their monthly premium payments?
Almost half of the insured Americans who reported medical debt said they owe $2,000 or more. That group alone amounts to roughly 15% of all working-age, privately insured adults in the country, not a fringe population, but a wide swath of the workforce.
Sara Collins, the study's lead author and a health economist at the Commonwealth Fund, told CBS News that insufficient coverage is the root cause:
"The primary reason why these people have debt is about the extent to which their insurance covers their out-of-pocket costs."
Collins described a financial reality that most working families already know firsthand. A single unexpected medical bill can wreck a household budget that is already stretched across rent, groceries, utilities, and transportation. The survey data backs that up: 37% of respondents with medical debt said they drained their savings to pay it down. Thirty percent reported cutting back on essentials, food, heat, or rent. And another 30% said they delayed or skipped medical care entirely, the very care their insurance is supposed to make accessible.
Collins put it bluntly:
"Most Americans don't have a lot of extra cash lying around, and when they are hit with an unexpected expense in a month when their income is allocated across all necessities of life, it can push people into medical debt they are unable to pay."
The survey's findings land hardest on families already operating on tight margins. Collins noted that low-income households run on regimented budgets where a single medical bill can tip the balance between stability and crisis:
"Especially among people who are low-income, they are on pretty regimented household budgets, and medical bills can really tip that budget over into the realm of not being able to pay for certain things and having to cut back."
That dynamic creates a vicious cycle. A family skips a doctor visit to avoid a bill it cannot pay. The condition worsens. The eventual hospital visit costs far more, and the debt grows. Meanwhile, the insurance card in the patient's wallet did nothing to prevent any of it.
Collins offered practical advice for consumers caught in this bind, urging them to verify that every charge on a medical bill is accurate before paying. "It's a tough situation to be in, but it's important to make sure what you are being asked to pay is correct," she said. Disputing erroneous charges and negotiating payment plans are among the steps patients can take, small consolation when the system itself is producing the problem.
The Commonwealth Fund report arrives at a moment when the cost of health coverage is climbing sharply for millions of Americans. Enhanced Affordable Care Act tax credits, originally created as a temporary COVID-19 relief measure in 2021 and later extended by Democrats, expired at the start of 2026, triggering average premium increases of 114% for more than 20 million subsidized enrollees.
An analysis by the Urban Institute and the Commonwealth Fund itself projected that roughly 4.8 million Americans would drop coverage entirely in 2026 because they can no longer afford it. Those people will join the ranks of the uninsured, and if they need medical care, they will face the full, uninsured price.
Congress had months to act. The Senate rejected two partisan health care bills in December: a Democratic proposal to extend subsidies for three years and a Republican alternative centered on health savings accounts. Neither passed. A potential House vote in January offered a last chance, but passage remained uncertain. The result is a policy vacuum in a midterm election year, with real families absorbing the consequences.
Katelin Provost, a 37-year-old single mother, watched her monthly premium jump from $85 to nearly $750. "It really bothers me that the middle class has moved from a squeeze to a full suffocation, and they continue to just pile on and leave it up to us," she said. Chad Bruns, a 58-year-old ACA enrollee in Wisconsin, was more direct: "Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it."
The Commonwealth Fund survey exposes a failure that cuts across party lines and across decades of health care policy. Americans did what they were told to do. They enrolled in coverage. They paid their premiums. And one in three of them still ended up in debt, not because they were reckless, but because the coverage they purchased left them exposed to costs they could not absorb.
Hospital visits account for the largest share of that debt, but routine care, the annual checkup, the blood draw, the imaging test, is piling up too. When patients owe thousands for the basics, the word "coverage" starts to lose its meaning.
The survey does not break down debt levels by insurance type, leaving an open question about whether employer plans, ACA marketplace policies, or other private coverage are driving the worst outcomes. It also does not specify when the survey was fielded or report a margin of error, gaps that limit how precisely the findings can be applied. But the broad picture is clear enough: the system is producing debt at scale among the very population it is supposed to protect.
Meanwhile, the expiration of ACA subsidies means millions more Americans are now paying dramatically higher premiums for plans that, if this survey is any guide, may still leave them on the hook for thousands in out-of-pocket costs. They are paying more to get less.
Washington spent years promising to fix health care. Americans are still waiting, and still getting the bills.