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Many scrimp despite work health plans

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More than one in five of the 57 million working-age Americans with chronic medical conditions - such as asthma, diabetes, and heart disease - had problems paying medical bills last year, according to a report to be released today.

As health costs have risen faster than wages, more workers - insured and uninsured alike - struggled last year to pay out-of-pocket costs, in some cases delaying needed treatment because the price tag was too high, the study found.

The report by the Center for Studying Health System Change, a nonpartisan policy group in Washington, D.C., was based on a nationwide survey of 24,500 families.

"The study provides strong evidence that rising health costs and increased patient cost-sharing are taking a heavy financial toll on low-income, chronically ill people, even if they have private health insurance," said Paul Ginsburg, center president.

The proportion of low-income, chronically ill patients with private health insurance who spent more than 5 percent of their income on out-of-pocket medical costs rose to 42 percent last year, from 28 percent two years earlier.

Low-income patients are defined as people with incomes below 200 percent of the federal poverty level, or $36,800 for a family of four last year.

Among low-income people, one in three of the privately insured and chronically ill lived in families that had problems paying medical bills.

Mounting medical costs meant that low-income people with insurance had problems getting care. Because of cost concerns:

* 10 percent went without needed care.

* 30 percent delayed care.

* 43 percent did not fill a prescription.

"The extent of the cost burden and the degree to which it impedes timely access to medical care are surprising and cause for concern," said study author Ha T. Tu.

Across the entire working-age population, people 18 to 64, chronically ill patients were almost 60 percent more likely to spend more than 5 percent of their income on medical expenses than people without on going health problems.

Among those who reported problems paying medical bills, 68 percent of families had problems affording other necessities such as food and shelter; 55 percent put off major purchases; 64 percent were contacted by a collection agency; and half had to borrow money. More than 9 in 10 families had at least one of these problems, and almost a quarter faced all four difficulties.

The full study will be available today at

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