One in four insured Americans go without care, struggle to pay high deductibles

A new Kaiser Family Foundation report finds that fewer than half of single people have the money to pay $2,000 in deductibles and other cost-sharing requirements in most commercial health plans. In sharp contrast to wealthy Americans who can afford high deductibles and copays, high cost-sharing too often keeps working people from getting needed care. With health plan deductibles and copays rising more quickly than people’s income, more Americans are unable to afford their care.

Commercial health plans for people under 65 typically have out-of-pocket limits of $6,850 for an individual and $13,700 for a family, far more than most Americans can afford. Only about half of people living alone have $2,500 in cash or other liquid assets. And, only about half of larger households have $5,000 in liquid assets. Slightly more than one in three households could pay $6,000 in cost sharing.

More than forty percent of people with incomes between 150% and 400% of the federal poverty level are at risk of going without care if they get sick, without the money to pay even a $1,500 deductible ($3,000 for families), the average deductible for people with employer coverage. About sixty percent of people in this income range could not afford a $3,000 deductible ($6,000 for families), which are typical in the state exchanges.

Access to care for working families in the US has declined in the last couple of years as health plans increasingly ration care based on people’s ability to pay. In 2015, Families USA reported that one in four Americans with non-group coverage—insured either through the health insurance exchanges or outside the health insurance exchanges—could not afford their medical care. They were unable to pay the high deductibles (which, according to the Kaiser report, averaged over $3,000 in 2016 and 2017) or out-of-pocket costs their policies require. As a result, they went without care they need.

In 2013 and 2014, 25.2 percent of people in non-group plans went without care because they were not able to pay for it. Not surprisingly, people with incomes between 139 and 249 percent of the federal poverty level had more trouble affording care (32.3%) than people with incomes between 250 and 399 percent of poverty (22.2%).

And almost three in ten people with deductibles of $1,500 or more (29.8%) went without medical care as compared with about two in ten people with deductibles under $1500 (19.6%). A somewhat smaller percentage of people who got their coverage through the state exchanges had deductibles of $1500 or more (42.8%) than people who got their coverage outside the exchanges (58.3%).

According to a September 2016 CDC report, in the first quarter of 2016, 40 percent of Americans were enrolled in high-deductible health plans, up from 36.7 percent in 2015 and from 25.3 percent in 2010.

The Families USA report found that the most common procedures people skipped were medical tests, treatments and follow-up visits (15.3%) and filling prescriptions (14.2%). Many prescription drugs have become prohibitively expensive even with insurance. Not only have prices on brand-name drugs gone up, but copays on brand-name drugs have risen signficantly, to as much as 30 percent of the cost. It’s no wonder that government drug price negotiation is a top policy issue for democrats and republicans alike.

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