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US rations care based on ability to pay

Written by Diane Archer
Making insured Americans pay high deductibles and large amounts in coinsurance and copays before they receive care is tantamount to rationing care based on the ability to pay. A new Gallup poll reveals that one-third of Americans have put off care because of the high cost.

If people were putting off unneeded care, this information would not be concerning.  But, because we generally don’t know what care we need and must rely on our doctors, we should assume that a large number of people in the U.S. are not receiving needed care because they deem it unaffordable. More than 10 million more Americans have health insurance because of the Affordable Care Act.  But, health insurance coverage has become less comprehensive in the last several years, leaving people to pay huge medical bills on top of their premiums.  So, it’s not surprising that 34 percent of Americans with private insurance have put off care.

Medicare protects people from unpredictable out-of-pocket costs better than other insurance by allowing people to have supplemental coverage and to budget for their care.  With supplemental coverage, you generally have no coinsurance and pay no deductibles. As a result, a far smaller percentage of people with Medicare (22 percent) say that they forego care because of cost.  The big problem with Medicare is that it does not cover most dental, vision or hearing care, nor does it cover long-term services and supports, all of which can be very costly.

No matter the type of insurance, income has a big role to play in whether people get care. The Gallup poll determined that 38 percent of people earning between $30,000 and $74,999 put off care because of the cost.  A far smaller percentage, 28 percent of people earning $75,000 or more, put off care because of cost.

Putting off care for a serious or relatively serious condition is of greatest concern.  And, to that question, the survey findings were particularly disturbing.  More than one in five respondents (22 percent) said that they had done so, twice the percentage as said so in last year’s poll.


  • My income is reasonable but I pay taxes on what I need to take out of my retirement and the cost of everything is increasing. I just retired at 87 because I needed to feel more secure when I did and if Obama continues to abuse us elderly I will not support any of his policies. What can he be thinking.! Just because I worked hard all my life he now plans to punish me?

  • My ACA health coverage premium on the silver plan went up 400% for 2015. I would not be able to meet that premium. So I went with the bronze plan in my state, Pa. That was a 10% increase in premium for a lesser plan. This bronze plan has a $5,000 deductible for the year, with a total out-of-pocket of $6,600. This is not health insurance. It’s catastrophic insurance. To keep you from going bankrupt. Most of the co-pays and co-insurance for services don’t start till the deductible is met. For very low income families who earn just over Medicaid eligibility limits, this is truly unaffordable health insurance. This is why a single payer health plan is needed in this country. But, it will not happen until we all band together and demand it from our elected representatives in government.

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