Older Adults Sacrificing Basic Needs Due to Healthcare Costs

Editor's Note: The research detailed below was conducted in partnership with West Health, a family of nonprofit and nonpartisan organizations focused on lowering healthcare costs for seniors.

WASHINGTON, D.C. -- The health problems Americans start facing when they reach 50 years of age are compounded when the high cost of healthcare prevents them from seeking treatment, taking their prescriptions or leading an otherwise healthy lifestyle. A survey of U.S. adults conducted by West Health and Gallup explored the various ways in which healthcare costs are affecting Americans aged 50 and older today.

The study shows that at least two-thirds of older Americans consider healthcare costs to be at least a minor financial burden. When looking at inability to pay for care, four in 10 report they are concerned; smaller but notable percentages are not seeking treatment, are skipping prescribed medicine or cutting back on basic needs such as food and utilities to pay for healthcare. These problems are generally worse for adults aged 50 to 64, as most do not yet qualify for Medicare, but they also affect those 65 and older.

Older Americans at Risk Due to Cost of Healthcare

More than a third of adults 65 and older (37%) are concerned they will not be able to pay for needed healthcare services in the next year, according to the most recent West Health-Gallup survey. The situation is even worse for older Americans who are not yet eligible for Medicare, with nearly half (45%) of adults aged 50 to 64 reporting the same concern level. This puts nearly 50 million adults aged 50 and older at risk for more severe illness and even death due to the cost of healthcare.

U.S. Department of Health and Human Services data show that out-of-pocket healthcare expenses for adults 65 and older rose 41% from 2009 to 2019; out-of-pocket expenses take up a greater proportion of individuals' expenditures as they age, because of an increase in demand for health services and the reality that Medicare does not cover all health expenses. People 65 and older spend nearly twice as much of their total expenditures on healthcare costs when compared with the general population, even with 94% in this age group being covered by Medicare.

As costs continue to climb over the next decade, the number of Americans 65 and older will also rise, by a rate of about 10,000 people per day, according to the U.S. Census. This rapidly growing group of older Americans -- which those currently 50-64 and aging into Medicare are entering -- is already saying healthcare costs are a financial burden (24% of those 50-64 call it a major burden; 48%, a minor burden). For substantial proportions of older Americans, this burden results in sacrificing basic needs to pay for healthcare -- about one in four adults 65 and older and three in 10 aged 50-64 cut back on food, utilities, clothing or medication due to healthcare costs. This hardship is experienced to a greater degree by older women and Black Americans.

The West Health-Gallup survey was conducted by web Sept. 27-30 and Oct. 18-21, 2021, via the nationally representative Gallup Panel. Full results of the study can be found in the West Health-Gallup 2021 Healthcare in America Report.

Adults 65 and Older Are Forgoing Needed Care

The West Health-Gallup survey shows that a sizable proportion of the older adult population copes with healthcare costs by skipping treatments and cutting back on basic and essential needs. The avoidance of vital medical care could compound negative health outcomes now and in the future.

Twelve percent of those 65 and older -- which represents approximately 6.5 million people -- say they or a member of their household had a health problem in the last year that they did not seek treatment for due to cost. Eleven percent of Americans in this age group -- 6 million people -- report that they or a family member skipped prescribed pills to save money.

Doreen Ferraro, a 71-year-old woman from New York, is one older American who has had to forgo care; she explains the calculus some older Americans go through when deciding on treatment: "I was supposed to have a back surgery, but I found out that the copay for the hospital was $350. That would wipe out any savings I have completely. So, I haven't had the surgery done, and I have great pain when I stand up."

Adults Aged 50-64 Face Acute Healthcare Challenge

Adults aged 50-64 have a particularly hard time affording healthcare, given that they are old enough to be experiencing health problems but too young to qualify for Medicare. About one in four such Americans (26%) -- more than twice the rate among adults 65 and older -- say they or a member of their household recently did not seek treatment because of the cost.

Another 18% of adults in this age group (also elevated in comparison with those 65+) say they or a family member has skipped prescribed medication to save money.

Lawana Baugus, a 61-year-old from Missouri, describes her concern with using healthcare: "I live under constant worry that one of us is going to have to go to the hospital. And we just don't have the money to pay … or make payments. So, we hesitate to even go to the hospital for anything."

One in Four Americans 65 and Older Sacrifice Needs to Pay for Healthcare

Paying for healthcare requires tough choices for a sizable minority of Americans aged 65 and older. Nearly two in three adults in this age group indicate that healthcare costs are a major (15%) or a minor (51%) financial burden. These costs are also associated with stress, which can make health issues even worse: Over four in 10 adults aged 65+ (42%) report that healthcare costs cause stress in their daily lives.

The West Health-Gallup study quantifies the extent to which older Americans are struggling to cover basic needs due to rising healthcare costs. In the past year, about one in four adults aged 65 and older, approximately 13 million people in this age group, cut back on at least one basic need to pay for healthcare. This group includes 9% who reduced spending on food, 13% who decreased spending on over-the-counter drugs, 6% who cut back on utilities and 19% on clothing.

Arthur Falconer, 78, from New Mexico, is one older American who has experienced this stress and the tradeoffs and explains his situation: "When I go to see a doctor, it costs $20, [which] may not seem like much to everybody, but my wife and I are retired, and we have a grand total of $126 left a month for gas, emergencies and food. We end up having to get food at the church food banks."

Financial Burden, Stress, Sacrifice More Prevalent for Adults Aged 50-64

More than seven in 10 adults aged 50-64 cite healthcare costs as at least a minor financial burden (24% major, 48% minor), and a majority in this age group (52%) say healthcare costs cause stress in their daily lives.

When it comes to covering basic needs to pay for healthcare, more Americans aged 50-64 face hardship. Three in 10 in this age group forgo at least one basic need to cover the costs of care. Specifically, 14% reduce spending on food, 15% cut back on over-the-counter drugs, and 26% buy less clothing. Similar to the situation for adults aged 65 and older, 8% of those aged 50-64 reduce spending on utilities to pay for healthcare.

Dawn Meritt, who is 59 years old and from Washington State, discusses the tradeoffs she has had to make: "Financially, I have to juggle and try to figure out where I can get money [for healthcare costs], so I take it from my electrical bill or my grocery bill … this winter I couldn't turn on my furnace because I couldn't afford it."

The results also highlight gender and racial differences in terms of the need to cut back on basic needs to pay for healthcare. For example, women aged 65 and older are more likely than men 65 and older to say they have cut back on clothing (22% vs. 15%, respectively), over-the-counter drugs (15% vs. 10%) and food (11% vs. 7%). Among those aged 50-64, 28% of women report reducing spending on clothing, compared with 23% of men.

Black Americans aged 50-64 are more likely than White Americans to report forgoing at least one basic need asked about in the survey (38% to 29%, respectively). Black Americans aged 50-64 are more than twice as likely as White Americans to say they cut back on utilities (15% vs. 7%). Black adults in this age group are also more likely than White adults to have reduced spending on clothing (31% vs. 24%) and over-the-counter drugs (19% vs. 13%).

Implications

The U.S. Census estimates that the aged 65 and older population will reach 77 million people by 2034, rising from about 52 million today. As sizable numbers of Americans 65 and older face tangible tradeoffs to pay for healthcare, many more Americans in the next decade will incur health and financial consequences because of high costs.

With adults aged 50-64 already sacrificing to a greater degree than their older counterparts, there will certainly be many older adults needing medical care because of the health outcomes of delaying or skipping treatment. According to the Organization for Economic Cooperation and Development, healthcare costs in the United States remain higher than those of other developed countries, but paying more for care is not resulting in better health outcomes.

Policymakers urgently need to grapple with how to improve efficiency and reduce costs of healthcare and prescription drugs in the United States, so Americans do not need to sacrifice basic needs to pay for healthcare or medicine -- or to avoid care entirely because it is too expensive.

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