The biggest health issue we aren’t debating

By Drew Altman
Axios, November 22, 2017

Thanksgiving is always a time to think about those in need. How about, then, a group we don’t worry about enough: the many lower and moderate income Americans who can’t cover their cost sharing if they get sick? It raises the question: How much cost sharing is too much?

High deductible plans, which require people to pay large amounts out of pocket before their medical bills are covered, are a good deal for some middle and upper income people. But many lower and moderate income Americans simply don’t have $1,500 to $3,000 to pay for the colonoscopy that might save their life, or a stress test that might reveal the heart disease which is the cause of their chest discomfort.

Share of non-elderly households with liquid assets less than their deductibles, among people with private insurance:

Deductible of $1500 single/$3000 family:
28% – All non-elderly households
63% – Less than 150% of federal poverty level (FPL)
44% – 150-400% of FPL
10% – 400% or more of FPL

Deductible of $3000 single/$6000 family:
40% – All non-elderly households
76% – Less than 1505 of FPL
60% – 150-400% of FPL
20% – 400% or more of FPL

The chart, drawn from a new study, tells the tale: More than four in 10 households with private coverage and incomes between 150% and 400% of the federal poverty line do not have enough liquid assets to cover a deductible of $1,500 for single people and $3,000 for families.

* That’s not a high deductible plan, but about the average in an employer-provided insurance plan.

* Sixty percent couldn’t cover deductibles double those amounts, which are not uncommon, especially in the individual insurance market.

For many families, even if they have insurance, any significant illness could wipe out all their savings, making impossible to fix a broken car to get to work, or pay for school, or make a rent or mortgage payment.

Congress has passed no law declaring that the country will go with high deductible coverage as its main approach to health insurance.…

Over one-fourth of all households with a $1500/$3000 deductible plan (average employer-sponsored plan) do not have enough liquid assets to pay their deductible and two-fifths of those with a $3000/$6000 deductible (modest high-deductible plan) cannot either, yet these plans have become fairly standard today. And as many as three-fourths of low-income families with private insurance do not have enough funds to pay their deductibles.

Tomorrow we are supposed to be giving thanks for what we do have, but how difficult will it be for families to give thanks when they wiped out their savings and still owe more because their health insurance coverage was inadequate? Too many couldn’t fix their broken car they need to get to work; they couldn’t pay for school; they couldn’t make the rent payment.

Tomorrow let us resolve to reach the day wherein absolutely everyone will be able to give thanks for being able to access the health care that they need without having to face financial hardship. Giving thanks for what we, as a nation, already have is not enough.

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