We Have Insurance, Still Can't Afford Care

About 91% of Americans are now covered by private or public health insurance through employers, the federal exchange, or Medicaid/Medicare. This impressive coverage rate is the highest in U.S. history, but lately critics, researchers, and policy-influencers are tipping the discourse toward the next big debate: Does coverage make health care affordable enough?

The root of the problem: runaway, out-of-pocket expenses are making it nearly impossible for many Americans, even with insurance, to make their medical bill payments and gain access to health services. This issue extends beyond people with health plans created through the Affordable Care Act and includes people with insurance through employers too. Forms of cost-sharing or out-of-pocket expenses include: high deductibles, out-of-network charges, medical and drug copayments, and coinsurance.

In The Wall Street Journal, Drew Altman, the president and CEO of Kaiser Family Foundation, analyzed the growing trends in patient spending on deductibles (a specified amount of money that the consumer must pay out-of-pocket first before an insurer pays for services). Their analysis showed a 256% increase in deductible payments from 2004 to 2014 for insured people through larger employers, while wages increased by only 32% during the same period. In 2014, deductible accounted for 47% of all cost-sharing, up from 24% in 2004. Indeed, consumer polls indicated that deductibles are their top health-cost concern.

Patient Spending on Deductibles Outpacing Wages
Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

"Ever larger deductibles may dampen growth in spending but can also be a significant burden for many family budgets and a barrier to care for the chronically ill," underscored Altman.

One in five working Americans with health coverage report problems with paying medical bills. Among this group, 63% report exhausting all their savings and 42% worked longer hours or took an extra job. News of the nation's largest insurer UnitedHealth Group exiting the federal exchange by 2017 will likely result in even less options for consumers and higher annual premiums.

Out-of-reach health services are particularly disconcerting for people who really need them on a regular basis, such as families with young children, the elderly, and people living with chronic and mental illnesses or disabilities. People living with HIV -- now treated as a chronic illness -- are living longer and healthier compared to three decades ago thanks to medical and drug advancements. However, diminished access to these critical services due to high cost-sharing is deepening the severity of hardships faced by many people living with HIV. Other consequences include decreased rates of drug adherence, increased viral-load counts, and therefore increased likelihood of transmission of the HIV virus within a community.

The cost of health care has long been a concern for Americans, but the debate is no longer focused on the insured versus uninsured -- again 91% of Americans now have health insurance -- but rather how much cost-sharing is too much? For the average American, concerns play out in the form of difficulty of paying medical bills and hindering access to care. As for the political world, it still needs to catch up on addressing this dire concern -- once it moves on beyond the Affordable Care Act.