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Familes USA: 1 In 4 Americans Who Purchased Health Insurance Still Can't Afford Medical Care


More than 14 million people in the United States gained health insurance through the Affordable Care Act, but a new study has found a serious flaw: sky-high deductibles that actually make it cheaper to go to the emergency room than schedule a visit with a physician. 

Families USA, a group that advocates on behalf of the health care law, says that while the Affordable Care Act is an historic success in expanding health coverage, simply having health insurance is no guarantee that consumers can afford to pay for health care.

Ron Pollack is executive director of Families USA.   "More than 1 out of 4 adults who had year-round non-group health coverage went without needed health-care because they could not afford it. It meant that they could not afford tests or that they could not afford various treatments or that they could not afford the cost of prescription medicine."

The report “Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care”cites high deductibles of $1,500 as the probable leading cause for missed care, such as medical tests, treatments and follow-up care.   "15.3 percent went without needed tests or follow-up care. 14.2 percent went without needed prescription medication. And mind you, when we're talking about people who went without needed medical care, we have excluded from that calculation people who went without needed dental care."

Lower- to middle-income adults were the most affected, with almost one out of three reporting they skipped needed health care because they couldn’t afford it.  Numbers crunched in the report come from data collected by the Urban Institute’s Health Reform Monitoring Survey in September 2013, September 2014 and December 2014.

Report co-author Lydia Mitts is working with actuaries to reconfigure silver plans in such a way that these plans would present less of a problem when it comes to high deductibles. Among possible solutions:   "State policymakers could require that every insurer in their state offer at least one silver plan that covers basic outpatient services and prescription drugs before the deductible is paid. Federal policymakers could take a similar step and require insurers in all states to offer a plan like this."

Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care - See more at: http://familiesusa.org/product/non-group-health-insurance-many-insured-americans-high-out-pocket-costs-forgo-needed-health#sthash.XwKOnjYW.dpuf
Mitts adds that creating silver-level plans with low cost-sharing would not automatically lead to dramatically higher premiums.  Families USA is suggesting state marketplaces look to New York, Connecticut and California, states that have crafted standardized plans that tend to exempt routine care from the deductible.   "Connecticut's marketplace is a really good example of this. They've created a standard silver plan that covers doctor's visits, including primary care visits and specialty care visits, tests and lab work, generic prescription drugs and a number of other outpatient services before the deductible is paid."

Calls for comment to the New York State of Health were not returned.

Dave Lucas is WAMC’s Capital Region Bureau Chief. Born and raised in Albany, he’s been involved in nearly every aspect of local radio since 1981. Before joining WAMC, Dave was a reporter and anchor at WGY in Schenectady. Prior to that he hosted talk shows on WYJB and WROW, including the 1999 series of overnight radio broadcasts tracking the JonBenet Ramsey murder case with a cast of callers and characters from all over the world via the internet. In 2012, Dave received a Communicator Award of Distinction for his WAMC news story "Fail: The NYS Flood Panel," which explores whether the damage from Hurricane Irene and Tropical Storm Lee could have been prevented or at least curbed. Dave began his radio career as a “morning personality” at WABY in Albany.
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