JustCare

Tag: Underinsured

  • More than 4 in 10 Americans face cost barriers to care

    More than 4 in 10 Americans face cost barriers to care

    At any given time, about 10 percent of Americans are responsible for 70 percent of health care spending. Since anyone can be hit by a car or diagnosed with cancer tomorrow, you could be among that ten percent facing very high health care costs, even with health insurance. Unfortunately, health insurers today too often do not provide people adequate coverage, leaving nearly a quarter of their enrollees underinsured, according to a new report by the Commonwealth Fund.

    In addition to underinsurance presenting a barrier to care for a large cohort of Americans, the Commonwealth Fund found that 12 percent of Americans went without health insurance during some point in the year. An additional nine percent of Americans surveyed were uninsured throughout the year.

    The Commonwealth Fund defines underinsurance as the plight of people with insurance who face high deductibles and copays relative to their income. As a result, these people are often inclined to forego or postpone care.

    All in, the Commonwealth Fund survey results show that almost half of Americans (44 percent) did not have insurance throughout the year and/or could not access affordable care even with insurance. Slightly more than half of Americans had insurance throughout the year with access to care they could afford.

    Some underinsured and uninsured Americans don’t need care or need little care and can manage. But nearly six in ten people (57 percent) who are underinsured and seven in ten who are uninsured reported going without needed care, including prescription medicines, medical tests, and medical procedures. The consequences of foregoing care can be dire, including preventable death and serious health conditions.

    Equally concerning, millions of uninsured and underinsured Americans face medical debt.

    Here’s more from Just Care:

  • 2022: Health care costs threaten the well-being of many Americans

    2022: Health care costs threaten the well-being of many Americans

    Fewer Americans are uninsured than ever–almost half the number before the Affordable Care Act took effect. But, rates of underinsurance are high, with millions of people having gaps in their coverage, millions skipping care and millions falling into medical debt because they cannot pay their health care bills. The Commonwealth Fund surveyed Americans and found that, too often, health care costs threaten their well-being.

    The big takeaways:

    • More than four in ten adults under 65 (43 percent) did not have adequate health insurance. People without insurance, people with gaps in insurance coverage during the year, and people who could not afford their care are included in this group.
    • Nearly three in ten people with employer coverage (29 percent) and more than four in ten people with coverage they bought in the individual market (44 percent) were underinsured.
    • Close to half of all people (46 percent) said that they had not gotten care or delayed getting care because of the cost. More than four in ten (42 percent) struggled to pay medical bills or were in medical debt.
    • Half of people surveyed (49 percent) said they could not afford to pay an unexpected medical bill of $1, 000 within 30 days, primarily people with low incomes (68 percent), Black adults (69 percent), and Latin/Hispanic adults (63 percent).

    Large numbers believe health care costs should be a top priority for the Biden administration and Congress. Democrats (68 percent), Independents (55 percent), and Republicans (46 percent).

    “Underinsured” is defined for people living above twice the federal poverty level as out-of-pocket health care costs over 12 months, excluding premiums, representing at least 10 percent of household income and for people living under twice the federal poverty level, representing at least 5 percent of household income ($27,180 for an individual and $55,500 for a family of four in 2022). Or, people whose health care deductible represented at least five percent of household income.

    People who lacked health insurance for at least a year tended to be young, poor, with one or more chronic conditions, living in the South, Latin/Hispanic. Undocumented individuals are not able to get affordable coverage.

    Because the US lacks a national health insurance program or even a national health insurance enrollment program, a lot of people who might be eligible for coverage based on their age, income and needs, go without coverage. More than half the people surveyed (56 percent) who had employer coverage but had been uninsured at some point during the year did not know that they were eligible to enroll in their state health insurance exchange plans because they lost their coverage.

    Americans likely would pay a lot less for their health care if the government set rates for all health care providers, as it does for people with Medicare. Because the US does not set provider rates–as all other wealthy countries do–these high rates drive high cost-sharing. Physician and hospital prices in the US are higher than anywhere else in the world.

    Close to one in four people with chronic conditions, such as diabetes, are not filling their prescriptions regularly because of the out-of-pocket cost.

    Of note, nearly one in four people with bills in collection said the bills stemmed from a mistake in billing. More than half of people with medical debt (56 percent) owed at least $2,000.

    Medical bills from out-of-network doctors at in-network hospitals represented almost half of all cost issues. These surprise bills are no longer permissible under the No Surprises Act, which took effect January 2022. But, the survey included a timeframe before then.

    When the public health emergency is declared over, likely in 2023, states will lose their improved federal matching funds. Inevitably, with less money, they will reconsider Medicaid eligibility and restrict coverage.

    Here’s more from Just Care:

  • Coronavirus: Blame corporate health insurers for our failure to contain it

    Coronavirus: Blame corporate health insurers for our failure to contain it

    Wendell Potter, a former health insurance executive at Cigna, knows first-hand how poorly corporate health insurers ensure that Americans get the care they need. They create all kinds of obstacles to care and coverage. In an interview with Philadelphia Magazine, Potter explains why corporate health insurers are to blame for our failure to contain the spread of the novel coronavirus; we need guaranteed universal health care to contain it.

    In the US, we have more than 30 million people who are uninsured. We also have nearly 50 million people who are underinsured; they have health insurance, but it is inadequate to enable them to get the care they need. Understandably, millions of Americans are not willing to take the risk that they will be able to afford the care they receive when they go to the hospital or the doctor’s office. As a result, many Americans are not seeking treatment for COVID-19.

    Canada has a government-administered universal health care system and a lower death rate from Covid-19 than the US. In Canada, there are no out-of-pocket costs for this care. Having universal coverage is critical to contain the spread of the coronavirus.

    In addition to universal coverage, you need a strong public health infrastructure and smart leadership. The UK has a system of government-administered universal care, but it has a higher COVID-19 death rate than the US. Prime Minister Boris Johnson was too slow in locking down the country, too slow in providing personal protective gear to health care workers and too slow in ensuring mass testing.

    Health care should be free at the point of service. Other wealthy countries do not charge their residents for care at the point of service. They simply tax their residents on a sliding scale for their coverage. In the US, the average out-of-pocket cost of COVID-19 treatment is somewhere between $9,000 and $20,000 for people with insurance. We ration care based on the ability to pay.

    The US also ties health insurance to employment. As a result, most of the 43 million people who have lost their jobs as a result of the pandemic were forced to find new coverage. We now know that at least 5.4 million of them could not. Many older adults are skipping needed care for fear of contracting the virus if they go to the doctor or the hospital. Some are dying. Their deaths are preventable.

    Federal law has no teeth when it comes to ensuring that people get needed care because we rely so heavily on private health insurers for people’s care. The recently passed CARES Act requires that COVID-19 testing be free in most instances. But, the federal government is hard-pressed to enforce the law and there are lots of grey areas. Some people who have negative test results are getting big bills. And, out-of-pocket costs for COVID-19 tests are all over the map.

    Meanwhile, health insurers are profiting nicely. United Healthcare earned $5 billion in profits in the first quarter of 2020, up 3 percent. Insurers are collecting premiums, but not paying out as many claims as usual because people are not going to the doctor or hospital for checkups and elective procedures.

    Congress is not likely to pass legislation that guarantees government-administered health care for all any time soon, even if a Democratic president is elected and we have a Democratic Congress. That said, Democratic voters favor Medicare for All.  The tide is turning. Potter says that it is becoming more difficult for health insurers to stop federal reforms that diminish their power.

    Here’s more from Just Care:

  • Medicare for All would lead to a better performing labor market

    Medicare for All would lead to a better performing labor market

    A new paper by Josh Bivens at the Economic Policy Institute makes the case that there is no reason that Medicare for All would reduce the number of jobs in the US. To the contrary, he finds that Medicare for All could increase people’s wages and create better jobs, helping families. An important by-product of enacting Medicare for All would be a far better performing labor market.

    How could Medicare for All increase wages? If employers gave the money they currently spend on their workers’ health insurance premiums back to their employees. Today health insurance premiums account for 8.4 percent of a typical worker’s total compensation. Economists like Emanuel Saez and Gabriel Zucman are proposing that Medicare for All require employers to return  all (or most) of the money they currently spend on their workers’ health insurance premiums to their workers in increased wages. Even if they gave all that money to their employees, employers would save money as they would not have the administrative expenses associated with providing health insurance, although they would have higher payroll contributions for Medicare and Social Security.

    Why would jobs be better? Everyone would have good affordable health care and would not have to worry about taking a job that they didn’t want because Medicare for All allows them to get the care they need when they need it. People would also experience less anxiety when they lost their jobs or were between jobs because they would still have health care coverage. Also, they would not feel locked into their jobs, if they wanted to leave, because they would always have health insurance.

    With Medicare for All, people would be more inclined to create their own jobs. Small businesses could grow and flourish, as people at these businesses would not have to worry about health care costs. Right now, the US ranks at the bottom of OECD countries in terms of people who are self-employed, at 6.3 percent. Small businesses are extremely risky because of the cost of health insurance and health care. Countries with universal health care, such as France, Spain and Germany, have between 9.9 percent and 16.0 percent self-employment.

    Why would there be more jobs? No question, Medicare for All would cause a shakeup in the job market as 1.8 million people working for insurers and in medical billing are projected to lose their jobs. But, the federal government would be paying for more health care, including dental, vision, hearing and long-term supports and services, creating more demand for health care and more jobs in the health care delivery space. 

    In addition, Medicare for All legislation should include support to help people who had been working for insurers and in medical billing to find new jobs. It’s not as big a lift as some believe. The number of people who would lose their jobs if Medicare for All were to be enacted is relatively small. It is about one-twelfth the number of people who lost jobs in 2018, 21.5 million.

    Today, about 87 million Americans are uninsured (23 million) or underinsured (64 million).  And, the cost of ensuring that people get the health care they need continues to grow. Health insurance premiums rose 20 percent in 2019. Prescription drug costs grew 9 percent. Prices keep going up far faster than in any other developed nation. For that to end, the federal government must step in to set prices for health care, as it would with Medicare for All.

    Here’s more from Just Care:

  • How high will health care prices go?

    How high will health care prices go?

    The incentives are aligned among health care providers and insurers–they all prosper when provider rates rise. Not surprisingly, doctor and hospital rates have risen significantly over the last several decades as well as more recently. How high will health care prices go?

    The Health Care Cost Institute (HCCI) reports price increases in metro areas of 13 percent between 2012 and 2016, based on an analysis of 1.8 billion claims. It also reports wildly different prices for standard medical procedures among metro areas and within metro areas. For example, prices in San Jose, CA and Anchorage, Alaska were 15 percent higher than the next highest metro area, San Francisco, CA.

    HCCI cannot explain why price varies so much among metro areas. Global budgeting–which means hospitals receive a fixed monthly rate for their services–would help with prices, as they do in Maryland. But, it would not help with utilization–the frequency with which services are delivered. And, utilization also varies wildly among metro areas.

    While people may disagree on how to address rising health care costs, few believe that we can afford to let health care spending continue to rise. Dr. Margaret Hamburg and William Frist write for Health Affairs, “Without some constraints on spending growth, we believe we will not be able to achieve a health care sector in this country that produces health and well-being for all.” Today there are 44 million underinsured (29 percent of insured adults), people with insurance that does not meet their needs. Back in 2003, 12 percent of insured adults were underinsured.

    So long as we rely on commercial health insurers to negotiate prices, prices will continue to  increase and health care costs will become even less affordable than they are today. Insurers generate more profits, the more health care prices rise. Their financial interests run counter to the public need for fair health care costs. Moreover, they often do not have the leverage to negotiate lower rates with hospitals and doctors, which effectively have monopoly pricing power in many communities.

    Medicare for All is the only legislation introduced in Congress that would rationalize health care prices and rein them in. Until Congress acts to regulate health care prices, as does every other wealthy country, millions of Americans who need costly health care services will be hard-pressed to afford them.

    I talk more about the benefits of Medicare for All on FAIR.org.

    Here’s more from Just Care: