Polling Data Note: Beyond the ACA, the Affordability of Insurance Has Been Deteriorating Since 2015
Kaiser Family Foundation, March 2, 2017
The debate about the future of the Affordable Care Act and its individual insurance marketplaces may be taking the focus off the affordability challenges facing the broader population, most of whom get their health coverage through employers, Medicare or Medicaid.
New survey findings from the Kaiser Family Foundation show that health care has become somewhat less affordable even among those with health insurance. Since 2015, larger shares of people with health insurance say they have a difficult time affording their health care costs: from 27 percent to 37 percent for premiums, 34 percent to 43 percent for deductibles, and from 24 percent to 31 percent for copays and prescription drugs.
Other findings include:
* About three in 10 adults (29%) report someone in their household has had problems paying medical bills in the past year, often with real consequences. For example, among those reporting problems paying medical bills, seven in 10 (73%) report cutting back spending on food, clothing, or basic household items, while about six in 10 report using up all or most of their savings (61%) or taking an extra job or working more hours (58%) to pay their bills.
* Concerns about cost are also affecting whether and when some people seek health care. For example, a quarter (27%) of the public says that they or a family member living in their household put off or delayed getting health care they needed in the past year due to costs, and nearly as many say they skipped a recommended medical test or treatment (23%) or did not fill a prescription (21%).
* Nearly half of Americans (45%) say they would have difficulty paying an unexpected $500 medical bill. This includes those who say they wouldn’t be able to pay it at all (19%), those who would put it on a credit card and pay it off over time (20%) and those who would have to borrow money from a bank, payday lender, family or friends (7%). Among the uninsured and those with lower incomes, more than three in ten say they would not be able to pay a $500 bill at all.
* Significant shares of the public say they are “very worried” about not being able to afford health care services they think they need (25%), losing their health insurance (22%), or not being able to afford prescription drugs (21%). Overall, half say they are at least somewhat worried that they won’t be able to afford needed health care services.
Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the polls were conducted from December 13-19, 2016 and February 13-19, 2017.
By Don McCanne, M.D.
At first blush this looks like just another one of those reports that shows that our health care financing system is not working as well as we would like it to. In fact, this is horrendous news. Let’s look at what this means.
This is brand new data collected after the Affordable Care Act (ACA) has been fully implemented. It provides a cross section of all sectors of the insured and uninsured, not just those in the ACA exchanges. The largest sector is those with employer-sponsored coverage – the mainstay of health insurance.
This survey shows that affordability continues to deteriorate, in spite of the benefits of ACA. More individuals and families are having problems paying medical bills to the extent that they have depleted their savings and are cutting back on other household essentials, including food!
Everyone should have the health care that she or he needs. Health care has become outrageously expensive. The health care financing system should be designed to allow people to circumnavigate the financial barriers to care. But what have we done instead?
For the majority of us we have turned the problem of high health care costs over to the private health insurers, pretending that they can use market forces to control health care costs for us. But what are they doing? They are protecting their own market for their insurance products by keeping their insurance premiums more or less affordable, but they are doing that by creating the very financial barriers from which insurance should be protecting us. Very high deductibles, coinsurance, copays, restricted benefits, narrow networks that create financial barriers to out-of-network physicians and hospitals – all are designed to shift health care financing from the insurance premiums to the pockets of patients. That’s great for the insurers but a disaster for patients.
And what is President Trump, HHS Secretary Price, and Congress offering us now? They have decided to reject the concept of guaranteed health care for all and replace it with the guarantee of ACCESS to insurance products and health care that we cannot afford. Some legislators are considering tax credits, but less that the subsidies under ACA. Affordability is already deteriorating and their proposals will only accelerate that deterioration.
We are already spending $3.2 trillion which is more than enough to provide quality care for everyone. But to do that we need to change to a financing system that would improve the allocation of these resources. A well designed single payer system would recover over $500 billion in wasted administrative services which would be enough to fill in the voids in care today. Also, we do not need to perpetuate cruel policies that block access to care by making it unaffordable in that other single payer tools can control spending in a patient-friendly manner (global budgeting, negotiated rates, bulk purchasing, budgeting of capital improvements, etc.).
Next week the House Energy and Commerce Committee is going to mark up the repeal and replace legislation. Their legislation would only make us even more susceptible to depleting our savings and forgoing basic essentials because of mounting medical bills.
This is catastrophic. It is time for a massive virtual march on Washington. We need far more than the National Mall could accommodate. This needs to go viral. We are all inundated with messages that we need to support health care for all – messages that you can click to donate a nominal amount. Bullshit! This is not simply about the administrative costs of our well-meaning advocacy organizations. This is about the health of our nation.
We need action! Now! Mobilize all of these groups that profess to support health care justice for all. Bombard Washington with 50 million demands for an improved Medicare for all. No, make that 100 million. They seem to be deaf in Washington.
Seriously, leaders of advocacy groups should organize conference calls today to initiate a process by which we could bombard Washington with electronic messages this weekend. The legislation moves forward next week. Remember that depleted savings and hunger are the default option.