Consumers could and should feel that they were misled about the supposed benefits from the health reform law, in particular the claim that it would lower insurance premiums and the average family’s health care costs. While there has been an expansion of coverage, on the commercial side that insurance almost always includes very high cost-sharing amounts. This is causing substantial stress on household finances, as confirmed in a Commonwealth Fund report. (Commonwealth Brief) The authors used the survey to construct a health care affordability index, which compares premiums and out-of-pocket costs to household income. The survey included people who had health coverage through their employer, those who got it from the exchanges and those who had individual coverage through traditional sales channels. According to the results, 13% of adults had unaffordable premiums, 10% had unaffordable deductibles and 11% had unaffordable out-of-pocket costs. Since there is overlap, 25% of all adults had a health care affordability problem. As you can imagine, the problem is most acute for low-income families, where 53% had unaffordable costs, compared to 30% of those in a middle-income category. These results came from an objective calculation of affordability. When consumers were asked about their perception of their premiums, deductibles and other out-of-pocket costs, they report much higher levels of difficulty in meeting these financial obligations. For example while the index says 10% of adults have an unaffordable deductible, 43% reported that it was impossible or very difficult for them to pay their deductible. And a significant percent of adults reported that the cost burden caused them to delay or avoid care, much of which appears to have been needed. And concerns about cost may lead to uninformed behavior, for example, preventive care is always free of any cost-sharing, but many adults reported avoiding it because of cost-sharing. It is not a bad thing for people to have some financial consequences in regard to their health and their health care, but consumers also need to be educated on and capable of making good decisions about the nature of their coverage and how to get good value for their health care spending. There is no easy solution to the health care cost problem, but lying to people to get the reform law passed only breeds cynicism and despair. And it is unconscionable that in the biggest source of the coverage expansion, Medicaid, people get far better coverage than that received by tax-paying workers.
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Two health care firms owned by private equity firms are merging in a transaction supposedly valued at $3 billion. HealthComp administers self-funded plans for employers and other groups and Virgin...
September 27, 2023
NextGen, an electronic medical records firm, is being put out of its public company misery, as a PE firm will pay $1.6 billion for the one-time high-flier.
September 7, 2023
A number of companies which attracted large financing rounds during the epidemic have imploded when reality set in. The latest is Cano Health, which is a little surprising since it...
August 15, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace