How Obamacare is affecting Americans' medical bills

In its first year, the Affordable Care Act is not only extending health-care coverage to more Americans, but it's also reducing their financial distress related to medical bills.

A new study from The Commonwealth Fund found that the share of American adults who reported trouble in paying their medical bills slipped to 23 percent last year, or 43 million people. That marks the first decline since 2005. By comparison, the percentage of Americans with trouble paying medical bills in 2012 stood at 30 percent, or roughly 55 million people.

Making it easier for people to deal with their health care costs was one of the goals of the ambitious law, which opened up federal and state-run health-care exchanges to provide uninsured individuals with insurance plans. The survey, which is conducted every two years and began in 2001, also found that the percentage of Americans who were contacted by a collection agency for unpaid medical bills declined to 15 percent last year, down from 18 percent in 2002.

Cost isn't as much as a barrier to seeking out medical care, either. The number of Americans who said they didn't seek out needed health care because of its cost declined for the first time since 2003. About 66 million Americans reported problems getting care because of cost last year, down from 80 million in 2012.

"What we're seeing, for the first time since we have been asking these questions, are that fewer adult are reporting they can't get health care because of costs," Sara Collins, vice president for health care coverage and access at The Commonwealth Fund and the study's lead author, told CBS MoneyWatch. "Fewer people are saying they are having difficulty in paying off medical debt over time."

Last year, about 6.7 million people enrolled in health-care plans through marketplaces set up under the Affordable Care Act. That helped lower the rate of uninsured adults from 19 percent of the U.S. population in 2012 to 16 percent in 2014, according to the Commonwealth Fund, a nonpartisan philanthropic organization focused on improving the health care system.

Among the groups that saw the greatest lift in health care coverage last year were young adults and families with incomes less than 200 percent of the federal poverty level (about $47,100 for a family of four). Young adults extended coverage through the ability to join a parent's policy and expanded eligibility for Medicaid, with the latter also helping low-income families.

While the decline in uninsured Americans has been noted by other research organizations, the law's impact on health care costs has been debated, with some critics claiming that businesses and workers would be hurt by expenses related to mandated enrollment.

Yet The Commonwealth Fund's findings may provide some reassurance that the law is helping American families, many of whom have been walloped by rising health care costs at a time when wages have remained stagnant.

Medical debt has hobbled millions of Americans, hurting their credit scores and creating other financial headaches. About 43 million Americans have an overdue medical debt on their credit reports, the Consumer Financial Protection Bureau said in a December report.

"Health insurance is about enabling people with the financial means to get health care and giving financial protections when they get sick," Collins said. The ACA "is enabling people to get the health care they need by removing barriers, and it's also reducing some of the major financial issues."

That's not only important for individuals, but for the the health care system and the overall economy, she added.

"The relief of the medical-bill problem frees peoples' income to spend on other life necessities," Collins said. "The issue is not something that only affects consumers; it also affects providers," given that unpaid bills from uninsured patients can undermine their financial stability.

While the report found improvement by many measures, Americans living in states that rejected the Medicaid expansion are lagging in health insurance coverage compared with those in states that widened access to the government health care program. In states that expanded Medicaid, only 19 percent of families with incomes below $24,000 lacked insurance last year, compared with 35 percent in states that didn't expand the program.