The Affordable Care Act Did Almost Nothing to Stop Medical Bankruptcies

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A new study out Wednesday in the American Journal of Public Health found the Affordable Care Act had little impact on the number of bankruptcies caused by medical problems. It’s a sign of how much about our broken healthcare system and social safety net has remained the same, and how deep the rot is.


The study randomly sampled court records of bankruptcy filers between 2013 and 2016 and mailed them a questionnaire, asking whether medical reasons—like bills or losing a job because of illness—contributed to their bankruptcy. Before the 2014 implementation of the bill, 65 percent cited a medical reason for bankruptcy; after, it was 67 percent. Overall, 58 percent cited medical expenses as a reason for bankruptcy. According to a Thursday press release from Physicians for a National Health Program, whose founders are among the study’s authors, it also found that people who reported a medical reason for bankruptcy “were two to three times more likely to skip needed medical care and medications.”

The list of medical reasons people gave for bankruptcies includes medical conditions causing job loss, with 44 percent of people surveyed saying it contributed to their bankruptcy. This is a major reason why employment-based insurance—the kind that public option plans work so hard to preserve—is such a bad idea: People lose their jobs all the time, and if that happens to coincide with a major illness, you might be screwed. It also underscores how barren the social safety net is in the U.S. Many states provide less than six months’ unemployment insurance, with some providing much less, and the amount you can actually receive in insurance is desperately low in many states. And there’s no mandated paid sick leave, so if you have cancer, your boss can refuse to pay you for time off you need for treatment.

The ACA left a lot of dreadful, cruel things about American health insurance untouched, but there’s a lot it could never have fixed. Even Medicare for All wouldn’t provide better financial support for people who lose jobs due to illness; it wouldn’t force Louisiana to offer more than $247 a week in unemployment benefits. But 79 million people have medical debt because of our private insurance-based system, and it’d sure be a good idea to stop adding to that figure.

Splinter politics writer.