As the federal government is seeking to expand the Obama Affordable Care Act by extending subsidies and giving more people coverage, bankruptcies linked to medical debt have not fallen. Instead, they have risen. Most Americans filing for bankruptcy over medical bills have medical insurance.

The Affordable Care Act failed to cure medical bankruptcies. A 2019 study found that “Medical problems contributed to 66.5% of all bankruptcies, a figure that is virtually unchanged since before the passage of the Affordable Care Act.” 

Another study, in the American Journal of Public Health, found that, “Despite gains in coverage and access to care from the ACA, our findings suggest that it did not change the proportion of bankruptcies with medical causes.”

Why? It’s simple. Costs get shifted; they don’t simply go away.

“Patient debt is piling up despite the landmark 2010 Affordable Care Act,” Kaiser Health News admits. “For many Americans, the law failed to live up to its promise of more affordable care. Instead, they’ve faced thousands of dollars in bills as health insurers shifted costs onto patients through higher deductibles.”

Health insurance does not protect you from medical bankruptcy.

One Illinois woman who filed for bankruptcy in 2016 says she felt powerless. “One of the biggest hurdles you face as a patient is just the sheer confusion of the process. You think you just show up and present your card, sometimes pay a copay, and that’s it. You don’t expect all these plan limitations and authorizations,” Jessica Hillman explained. “What are you going to do if your authorization gets denied? You don’t really have a choice to not go get care. All these processes that are in the finest of fine print. And sometimes it feels like you are literally paying for nothing.”

That’s especially true for Medicaid recipients. They have trouble getting appointments, and when they do, they don’t get much time with a health care provider.

It’s no wonder Americans have a very dim view of the U.S. health care system. Gallup says that 70% of Americans feel the system has major problems — or even that it’s in crisis.

Politicians are focusing their efforts on Medicaid expansion and other insurance-based approaches; but Americans wish they would focus on the real problem: health care costs.

What prescription will work? Let’s start with price transparency. People deserve to know up-front what they’ll be expected to pay.

Health care price transparency is incredibly popular with Americans. More than 50% of Americans have received or know someone who has received an unexpected and overpriced medical bill. Nearly 90% of Americans support requiring hospitals to post actual prices, not estimates. And 82% support strengthening penalties on noncompliant hospitals.

Just like “you can keep your doctor” and “you can keep your policy,” the pledge that the Affordable Care Act would reduce medical bankruptcies has proven to be a hollow promise.