b'Americans Continue to Struggle with Health Care Costs: HealthWell Foundation Removes the ObstaclesA dozen years after the Affordable Care Act passed, the number of Americans covered by health insurance is higher23% of working-age adults were than ever. Yet many still faced barriers paying for health careunderinsured in 2022in 2022. One of the main obstacles: underinsurance and wallet-draining out-of-pocket costs for prescriptions andSource: The State of U.S. Health Insurance in 2022, The Commonwealth Fundhealth insurance premiums.People who have chronic and life-altering illnesses often face mounting medical bills they cannot pay, even38% of Americans report postponing when they have medical insurance. What happens then?medical treatment due to costThey put off diagnostic tests, doctors appointments and surgeries. They skip pills and other prescribed treatments.Source: Gallup Annual Health and Health Care Poll, 2022Or they exhaust all their savings and go into debt to pay for their health. None of these tough decisions is acceptable, nor are the poor health outcomes that can result.Consider a cancer diagnosis. Nearly 2 million Americans are diagnosed with cancer each year. After the shock of$42,000: medical care and drug costs the diagnosis comes the shock of how to pay for treatment,in the first year of a cancer diagnosisespecially if the diagnosis forces the patient to leave the workforce as up to 85% of cancer patients do. And its notSource: Medical Care Costs Associated with Cancer Survivorship in the United just the cancer patient who suffers financially. Informal familyStates, AACRcaregiversthere are about 6 million of them caring for people with cancerhave out-of-pocket costs that can reach several thousand dollars a month, leaving them vulnerable to long-term financial strain as well as mental health distress.Medical debt is more common than many think, and it can lead to a worsening of social determinants of health100 million Americans are saddled (SDOH) including housing and food insecurity, which inwith health care debtturn is associated with adverse mental and physical health outcomes. It can be a vicious cycle, especially amongSource: KFF Health Care Debt Survey, 2022middle-class and low-income households, and can inhibit people from seeking further care. Medical debt is also deepening racial disparities.High inflation in 2022 spurred additional financial hardships for many Americans. Some help came in the form of pandemic-era subsidies for marketplace health insurance plans. The 2022 Inflation Reduction Act (IRA) extended those plans for another three years and lowered certain prescription drug prices and out-of-pocket costs for Medicare beneficiaries. HealthWell Foundation is following the implementation of the IRA closely, and we look forward to the additional relief it will provide to Americans who struggle to pay for their health care. We firmly believe that nobody should be left unserved by the health care system, regardless of their inability to pay for needed care. Thats why we put patients first in everything we do. PAGE 2 HEALTHWELL FOUNDATION 2022 ANNUAL REPORT'