The projected annual inflation rate in the U.S. reached 6.8% in November, up from 1.4% in January and the highest since the Reagan administration.

November projections have seen significant increases in energy cost (+33.3%), gasoline (+58.1%), housing increasing (+3.8%) and food cost (+6.1%) compared to this time last year.

New vehicles are up 11.1%, while used cars and trucks are up a staggering 31.4%.

The cost of health care has only increased 2.1% over last year, which matches the rate of the last several years. Surprisingly, these numbers appear to be in direct conflict with the way Americans perceive health care costs.

A recent Gallup report revealed that Americans are deeply concerned about the cost of health care and prescription drugs, with 30% of households reporting that they avoided seeking treatment for medical problems over the last three months due to the cost.

In addition, the report revealed that 71% of the country feels that they are paying too much for the quality of health care received and 48% feel that our health care system is getting worse.

Concern for health care costs fall along economic lines. Even though health care costs have only increased marginally, lower- and middle-income earners are still feeling the pinch.

Among households with an annual income of $24,000 or less, 34% did not seek treatment due to costs, compared to 37% of households making $24,000-$48,000 and 36% of those earning $48,000-$90,000.

Concerns decline as household income increases, with only 18% of households with an income of $180,000 or more reporting that they didn’t seek treatment due to the cost of care.

The same demographic study shows that middle-income households could not afford needed medication during the last three months: 21% for $24,000-$48,000-income and 16% for $48,000-$90,000-income households.

These rates are typically seen among social security recipients or retirees who are on a fixed income.

Concern for health care costs is a trend that has been growing all year.

In March, 29% of Americans reported that their health care cost had increased over the last year. By October, that number had increased to 50%.

While rates have increased, they have done so at a pace very similar to recent years. So, what might be influencing perceptions about costs?

A shallow explanation is that perception is linked to general financial pressures and the emotional fatigue of being in a pandemic for two years.

These challenges are coupled with the summer’s surge in COVID-19 hospitalizations and an anticipated 5% increase in employee health insurance premiums in the coming year.

This explanation seems a little short-sighted and overlooks what is happening to the middle class. So, a more significant answer should look at the health care marketplace over the last decade.

While the Affordable Care Act (ACA) helped millions of Americans gain basic health insurance coverage and helped to slow the rate of health care inflation, it did not bring down costs or help Americans with existing medical debt.

U.S. Census Bureau data from 2017 revealed that 19% of U.S. households carried medical debt. Black households were impacted the most at a rate of 27.5%.

It is safe to assume that these percentages are even higher after the last two years.

As Americans are carrying more and more health care debt, the public is seeing reports about aggressive health care system collection practices due to the rise in unpaid medical bills.

Most notable was the University of Virginia Health System (UVA), which filed 36,000 lawsuits over six years against former patients for unpaid debts. More recently, the Tennessee-based for-profit Community Health Systems (CHS) filed over 19,000 lawsuits from March 2020 to May 2021.

UVA and CHS are not alone among health systems nationwide, which is why it is estimated that the country has over $140 billion dollars of unpaid medical bills.

Despite the ACA, the rate of medical related bankruptcies has still not declined, and a 2019 study found that 66.5% of all bankruptcies are linked to medical issues.

The current problem may not be health care inflation as much as a decade of medical bills that have stacked up, crushing lower- and middle-income families.

Too many families are still paying for emergency health care costs incurred five, 10 or even 15 years ago. More often than not, these families are minorities.

From this perspective, it is easy to see why lower- and middle-income households are avoiding medical treatment. The costs are astronomical, and the public hears constant stories of families losing their homes and everything they worked for due to medical debt.

Unfortunately, avoiding treatment does not avoid costs either. Medical problems that go untreated only create larger health care concerns and, yes, larger expenses later that can become crushing debt.

Ironically, in an era of polarization on every topic from immigration and taxation to parental rights and abortion, health care costs have become a bipartisan issue at the grassroots level, with both Democrats and Republicans prioritizing health and the need to lower costs for care and treatment.

Unfortunately, 66% of voters think they have no power to change things and are pessimistic that the federal government is willing to enact policies to reduce cost.

With such a pressing need among lower- and middle-income households, and a growing outrage among average voters, it is time for our legislators and policymakers to set partisanship aside and push for a viable solution.

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