Seriously sick? Insurance likely isn’t enough
The whole point of health insurance is protection from financial ruin in case of catastrophic, costly health problems. But a recent survey of people facing such problems shows that it often fails in that basic function.
The survey, of some of the country’s most seriously ill people, found that even with health insurance, more than a third of the respondents had spent all or most of their savings while sick. They are often faced with deductibles and copayments; treatments their insurance won’t cover; and financial challenges — like lost work — that health insurance alone can’t address.
The New York Times, the Commonwealth Fund and the Harvard T.H. Chan School of Public Health used the survey to examine the sliver of the U.S. population who use the health care system the most. To be included in the results, a respondent had to have been hospitalized twice in the last two years, and to have seen at least three doctors. In some cases, when patients had died or were too ill to answer questions, relatives who had taken care of them participated in their place.
Their experiences may serve as an early warning system for problems that all of us may face: Because the estimated 40 million people in this population visit doctors, hospitals, nursing homes and pharmacies the most, they are the likeliest to see the weak points in the health care system.
One of these is financial insecurity. Among people with health insurance, more than 20 percent had trouble paying for basic necessities. More than a quarter had bills in collection, and 13 percent had borrowed money as a result of their illness.
Health insurance provided some protection against such outcomes — those in the survey who were uninsured were even more likely to face mounting bills and debts — but the insurance was generally not enough. The intensity of care increased the number of copayments those surveyed faced, and it increased the chances of receiving the kind of treatment that their insurance denied. And they were most likely to get stuck paying insurance deductibles, which have been steadily rising over the past two decades.
Thirty-one percent of people in the survey said they were unsure what their health insurance would pay for. Forty-two percent said they’d received a hospital bill that their insurance had not fully covered. Twenty-six percent said a treatment their doctor recommended was denied by their insurance.
“What’s staggering here is there’s no way people could know what they would be in for,” said Robert Blendon, a professor at Harvard who helped devise the survey. “They don’t know what their insurance covers. The consequences for people are quite extraordinary.”
Tristan Berger, 47, who was born with spina bifida, has had 16 reconstructive operations on his feet since age 13. A decade ago, he found himself too disabled to continue working, after a series of falls. His wife has health insurance through her job at Walmart, and he has some income from the Social Security disability program, but nearly all of it goes to his medical bills.
Berger, who lives in Tucson, Ariz., said he spent $12,000 last year on care not covered by his health insurance.
“You sit there every month trying to figure out what bill to pay: Do you pay the hospital bill or do you pay the utility bill?” he said. “There’s no savings. We’re part of that percentage of America that are one paycheck from being destitute.”