A recent survey from the Urban Institute’s Health Policy Center found that fewer adults younger than 65 reported problems paying family medical bills than they did in September 2013. In 2013, just before the first health insurance marketplace open enrollment period under the Affordable Care Act, 22.0 percent of adults under 65 reported difficulty. In March 2015, just after the second open enrollment period ended, only 17.3 percent did. This represents a decrease of an estimated 9.4 million Americans who reported difficulty paying medical bills, according to the institute’s Health Reform Monitoring Survey.

In addition, the decrease was experienced in both Medicaid expansion and nonexpansion states.

Adults are more likely to report problems paying medical bills if they have low incomes, are uninsured, have a high-deductible health plan or have higher health care needs because of poor health. They are also most likely to forego needed health care because they cannot afford it.