More Americans have health insurance now than at any time in the past decade, but many are finding that even with coverage they cannot afford the deductibles, co-payments and surprise medical bills that may come with using healthcare, according to results released Friday from a national survey conducted by the nonprofit Commonwealth Fund.
The telephone survey of 2,700 insured adults found that even those with employer-sponsored insurance, which is the most common form of coverage in the country, have trouble affording their healthcare expenses — leading to many to skip needed medical care and to not fill prescriptions.
“There are still many people with all types of coverage who have trouble getting care because of high costs,” said David Blumenthal, a physician and president of the Commonwealth Fund.
According to an “affordability index” created by the Commonwealth Fund to measure survey responses, healthcare costs are unaffordable for 25 percent of privately insured working-age adults.
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40% Adults who delayed or avoided needed care because of a high deductible relative to their income.
The index measures premiums, deductibles and out-of-pocket spending, such as co-payments, as compared to income. Of those surveyed, about 90 percent had employer coverage. About 6 percent of those surveyed had a plan through the Affordable Care Act exchange, and 5 percent had individual plans.
For the index, researchers considered premiums “unaffordable” if they cost more than 10 percent of an individual or family’s annual income, or more than 7 percent for low-income people ($23,340 for an individual and $47,700 for a family of four).
Deductibles, or the amount that a consumer must spend before coverage kicks in, were considered unaffordable if they equaled 5 percent or more of annual income.
High deductibles were a primary reason people struggled with healthcare expenses, with 43 percent of those surveyed saying their deductible is difficult or impossible to afford.
Most respondents found their premiums and co-payments easier to afford than deductibles. Still, about 34 percent of low-income adults reported difficulty affording their co-payments.
Another troubling finding: Many people are uninformed about their benefits under the Affordable Care Act, such as vaccinations, annual wellness visits, and cancer and other health screenings.
Two of five privately insured adults surveyed said it was difficult or impossible to afford their deductible.
Still, one in three adults surveyed said that their health plan did not cover those services, or that they didn't know if it did.
And among those who buy plans on the ACA exchange, many low-income Americans are unaware of subsidies that can lower their costs, said Sara Collins, lead author of the report and vice president for healthcare coverage and access at the Commonwealth Fund.
“They’re choosing lower premium plans,” she said. “It's more important to their decision than the deductible and the doctors that are covered in their network.”
About 26 percent of survey respondents said they had received a bill from a doctor or hospital that was out of network and not covered by their insurance, Collins said.
Among the solutions suggested in the report are public policies that protect consumers. Collins cited as an example California’s adoption of specific rules governing how much insurers can charge consumers for office visits, drugs or emergency room care.
Blumenthal and Collins also emphasized that despite some of the financial hardships of health insurance, most consumers reported being better off with coverage than without it. And they stressed that consumers’ struggles with medical expenses did not begin with federal healthcare reform.
“This problem of affordability did not start with the Affordable Care Act,” Blumenthal said. “It has been evolving over time, and it has continued to evolve.”