One Quarter Of Insured Still Can't Afford Care

By Christine Kern, contributing writer

High deductibles keep families from utilizing their health insurance plans.

One in four of those with health insurance coverage still can’t afford to utilize their health insurance plans due to high deductibles according to a Families USA study despite the fact the Affordable Care Act has increased access to health insurance. But just because people have insurance, it does not mean that they can actually afford the health care that it promises.

In fact, high deductibles mean it’s still often cheaper for people to go to the ER than to arrange a visit with a physician. The group’s report points toward plans with deductibles of $1,500 or more as the most likely leading cause for patients skipping medical tests, treatments, and follow-up care.

The advocacy group argues simply having health insurance does not guarantee that enrollees can actually utilize their plan to obtain healthcare, and the report suggests that silver plans should be reconfigured to include lower deductibles, making the plans actually effective for member use. Most commonly skipped categories of care included medical tests, treatments and follow-up care, according to the report, Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care.

“It is critically important that consumers be able to afford all of these types of care,” the report said. “Not getting follow up care to treat an illness or not taking needed medications can result in people facing avoidable, more serious health problems and more expensive health care costs down the road.”

The gap in care was most common among lower- to middle-income adults, with almost one out of three (32.3 percent) reporting they skipped needed health care because they couldn’t afford it. “Our findings show that too many lower- and middle-income consumers face deductibles that are likely unaffordable relative to their incomes and that could create barriers to them getting the care they need.”

“State policymakers could require that every insurer in their state offer at least one silver plan that covers basic outpatient services and prescription drugs before the deductible is paid. Federal policymakers could take a similar step and require insurers in all states to offer a plan like this,” report co-author Lydia Mitts told Northeast Public Radio.

Mitts explained that such plans would not automatically mean higher premiums, and pointed to the examples of state marketplaces in New York, Connecticut, and California, where there are standardized plans that exempt routine care from the deductible.

“Connecticut’s marketplace is a really good example of this,” Mitts says. “They’ve created a standard silver plan that covers doctor’s visits, including primary care visits and specialty care visits, tests and lab work, generic prescription drugs and a number of other outpatient services before the deductible is paid.”