Health Care Act

You got health insurance, but can you afford care?

Originally published Feb. 13, 2015.

As the 2015 push for health-insurance enrollment winds down, the next challenge grows ever clearer: Insured people who can't afford medical care.

The New York Times Sunday Review carried an article titled "Insured, but Not Covered." Reporter Elisabeth Rosenthal explores trends in insurance and health care that are leaving people with insurance unable to find doctors or pay bills.

Her conclusion: While the Affordable Care Act has brought coverage to roughly 10 million Americans and eliminated "some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills," the law has also adopted policies that "may in some ways be undermining its signature promise: health care that is accessible and affordable for all."

A key culprit is the boom in high-deductible policies, which allow employers and private buyers to reduce premiums by agreeing to much higher out-of-pocket costs.

For instance, HealthSherpa recently sent along an analysis of 14,000 North Carolina health insurance purchases made on the company's web site, which provides an alternative path for buying subsidized plans on the ACA exchange. Those buyers had an average household income of about $20,400 and bought policies that averaged $70 a month for the buyer, with the government kicking in an average of $381 a month.

But the average deductible per enrollee was $3,969 and the average out-of-pocket max was $5,745. Can you imagine anyone making less than $21,000 a year being able to save $4,000 to $6,000 to cover those costs? Reality is, even paying a couple of hundred dollars may be daunting enough to discourage people from going to the doctor's office.

A recent report from The Commonwealth Fund showed that the number of people skipping care because of costs declined in 2014, the first time since the question was added to the fund's health insurance survey in 2003. But while the numbers fell significantly compared with 2013, the year before the ACA took effect, the report estimates that 66 million Americans, or 36 percent of adults, still skipped an office visit, test, treatment or prescription because they couldn't afford it.