The number of Americans with health insurance reached a historic high during the COVID-19 pandemic, but there are darker shades among the bright spots.
The story was also published in Stateline, an initiative of The Pew Charitable Trusts.
Many Americans have policies that offer limited financial protection, and many patients report withholding necessary medical care or prescriptions to avoid facing out-of-pocket penalties. doing.
These are some of the results of a new health insurance study conducted by the Commonwealth Fund, a private research foundation that promotes quality and equitable health care.
The survey follows other health-insurance data, including those released by the U.S. Census Bureau from its annual American Community Survey, showing more than ever due to specific pandemic measures, particularly those passed by Congress. of people prove they have health insurance.
According to the American Community Survey, nearly 299 million Americans will have health insurance in 2021, the highest number ever and the number of Americans without health insurance in 2021 will surpass 28 million) decreased by 1.4 million from 2019.
During the pandemic, Congress banned states from unenrolling anyone from Medicaid, health insurance for low-income Americans. We have also increased subsidies to help pay for insurance.
However, increased insurance does not always provide adequate financial protection and thus necessary medical care.
The Affordable Care Act requires insurance plans to provide certain benefits, but does not eliminate copayments or deductibles that patients must pay.
“The big ‘but’ is it’s great that more people have insurance,” said Gideon Lukens, director of health policy research and data analytics at the Center for Budget, a left-leaning research institute. , that’s also half the battle.” Policy priority. “We need to ensure that people with insurance have access, and not have to sacrifice financial security to get it.”
Health policy analysts say Congress and states could take further steps to thicken health insurance rolls and protect the financial security of patients.
inadequate insurance
The Commonwealth Fund survey, conducted from March 28 to July 4 this year, interviewed 8,022 adults between the ages of 18 and 65.
That is, they either had no insurance (9%), had gaps in coverage compared to the previous year (11%), or had insurance all year round but were “adequately insured.” not” (which Commonwealth defines as coverage that still does not provide affordable access). Healthcare (23%).
As a result, Americans are in worse health than they actually are, said Commonwealth senior researcher and vice president Sarah Collins, who co-authored an analysis of the foundation’s findings.
“If you’re delaying a visit or not getting a prescription because of medical bills, it means your overall health isn’t as good as it used to be,” she said. It affects not only livelihoods, but also the productivity of employers and the health of the economy as a whole.Financially, it has a huge impact on people in terms of medical debt.”
Commonwealth considered themselves underinsured if they experienced one of three situations:
- Excluding health insurance premiums, individuals faced out-of-pocket medical costs equal to at least 10% of household income in the last 12 months.
- Out-of-pocket costs, excluding premiums in the previous year, were at least 5% of household income for individuals whose income was below 200% of the federal poverty line ($27,180 for individuals and $27,180 for households in 2022). $55,500). family of four).
- The health insurance deduction requirement was at least 5% of household income.
The study found that more than 4 in 10 people with a personal health insurance plan in 2022 are underinsured, including those who purchased a plan on the Affordable Care Act marketplace. understood. But she also reports that nearly 30% of people with employer-sponsored health insurance fall into the same category.
According to U.S. Census Bureau data, more than 164 million people will have health insurance through their jobs in 2021.
The study also found that people with lower incomes were more likely to be inadequately insured. So did those who considered themselves to be in fair or poor health, and those who identified as having at least one chronic health condition, such as diabetes or high blood pressure.
Those who had not had insurance for at least a year or had insufficient insurance reported a much higher rate of difficulty accessing treatment due to cost. They did not seek care when they had a medical problem; skipped recommended treatment, testing, or follow-up visits; did not see a specialist when needed; I didn’t.
Overall, 61% of those thought to be underinsured and 71% of those who were uninsured throughout the year were unable to get the medical care they needed because of the cost. . Of those who had adequate insurance for the entire year, he was less than one-third hers without it.
A high percentage of people with chronic health conditions also said they did not fill prescriptions in the previous year due to costs. At least a quarter of them did.
Two-thirds of those who were underinsured or had gaps in coverage in 2018 said they had health care costs, and many faced health care debt. or sacrificed other parts of their lives to pay for out-of-pocket medical expenses. Many have reported long-term effects, including damage to their credit ratings, investment in savings, and inability to pay for other necessities such as food, heat, and rent.
Half of those surveyed said they were unable to cover an unexpected $1,000 medical bill within 30 days. Among blacks (69%) and Latinos (63%), the percentage was even higher.
Potential condition fix
One of the most effective ways to remedy inadequate health coverage, Collins said, is because the last 12 holdout states (mostly in the South) are allowed under the Affordable Care Act. said its goal was to expand Medicaid eligibility to all adults whose income is up to 138%. poverty level. With this step alone, he could have an additional 3.7 million insured.
As other data confirm, the Commonwealth report found that the uninsured were disproportionately young, Latinx, low-income, and lived in the South.
The recently passed Federal Inflation Reduction Act extended pandemic-era subsidies for health insurance plans on the market for another three years. This will allow more people to pay their premiums.
However, once the COVID-19 public health emergency ends, health insurance coverage is likely to decline, most likely in 2023. That’s when the moratorium on unenrolling Medicaid recipients will also end. This change would require states to re-evaluate the eligibility of all Medicaid patients, and millions of people, including those who need to qualify, would be forced out of the program due to bureaucratic snafu and bureaucracy. You run the risk of being kicked out.
Collins said Congress could make further changes to market rules to reduce out-of-pocket costs for beneficiaries. Subsidies are currently pegged to the so-called Silver Plan, which offers 70% actuarial cover. That means it typically covers up to 70% of a person’s medical expenses. Commonwealth recommends pegging the subsidy to the Gold Plan, which covers his 80% of medical expenses.
Changing the benchmark to the Gold plan makes those plans more affordable. It would also be more costly for the federal government, as more subsidies would be paid, and could be harder to sell to lawmakers.
Over the past two years, nearly a dozen states have adopted measures to protect residents facing medical debt, and consumer advocates expect more states to introduce legislation next year. increase.
Collins said more states could also offer low-income assistance. The federal government provides subsidies to help low-income Americans pay for out-of-pocket medical costs, but some states discourage people from paying premiums or reducing out-of-pocket costs. It may also help or provide assistance. They include California, Colorado, Massachusetts, New Jersey, Washington and Vermont.
Collins said more states could follow Rhode Island’s path of using insurance regulations to try to slow the rise in fees charged by health care providers, thereby reducing health insurance premiums. said it was possible.
Three states, Colorado, Nevada, and Washington, plan to create or launch public option health insurance plans that offer low-cost health insurance.
Advocates say it will help, but almost as important as having health insurance is how much is left for beneficiaries, health policy experts say.
Justin Giovannell, project director at Georgetown University’s Center for Health Insurance Reform, said:
This story is available through Stateline, an initiative of Pew Charitable Trusts.
