Surprise! Understanding American Experiences with Surprise Medical Bills

• In Event: Engagement and Participation in US Health Politics

Abstract

Over the past two years, the Kaiser Family Foundation has used its ‘Bill of the Month’ reporting series to highlight stories of Americans of all walks of life struggling with surprise medical bills. Their reporting has documented troubling stories of families facing unexpected, and at times massive, bills for medical care they thought would be covered by their insurance. Recent examples include a family billed $143,000 for their child’s snakebite, a $541,000 bill for dialysis, and a $2,600 bill to remove a toy shoe from a child’s nostril. While these stories have been critical in revealing key gaps in American health insurance and the financial burden these gaps place on Americans, we still know very little about surprise bills nationally. Moreover, we know even less about their consequences. With the United States Congress considering surprise bill legislation, more research is needed to know the level of concern in the American public about surprise bills, how common surprise bills really are, and who is most likely to experience them. Perhaps most importantly from a policy perspective, we also need a better understanding of the levels of public support for potential policy change in this area.
Using an original national survey of 4,998 American adults weighted to population benchmarks, our research explores these important questions. Our research finds that surprise bills are pervasive in American society, with over 57% of Americans noting that they or a family member have experienced at least one surprise medical bill. Our work also shows that concern about receiving a surprise bill is widespread, with almost 70% of Americans at least somewhat concerned about surprise bills, with the most concern among the educated, women, and those who have past experience with surprise bills. We further find that surprise bills are significantly more likely to happen to the educated, older Americans, Hispanics, and those that do not live in Medicaid expansion states. Critically, when respondents were asked about possible government action to address surprise medical bills, we find high levels of support for government action among those who have experienced a surprise bill and Blacks. Conversely, we find opposition to government action on surprise bills from Republicans. We conclude by discussing the implications of these findings for American health insurance, media efforts to publicize surprise medical bills, and Congressional efforts to change health policy in this area.

Authors

• Timothy Herbert Callaghan, Texas A&M University

• Simon F. Haeder, The Pennsylvania State University

• Steven M. Sylvester, Utah Valley University