Many patients can’t afford health costs even with insurance
The number of Americans with health insurance has climbed to historic highs during the COVID-19 pandemic, but within that silver lining is a darker hue.
Many Americans have policies that only provide limited financial protection, to the point that many patients report forgoing needed medical care or prescriptions to avoid being hit with punishing out-of-pocket costs.
Those are some of the findings from a new health insurance survey conducted by the Commonwealth Fund, a private research foundation that promotes high-quality, equitable health care.
The survey comes on the heels of other health insurance data, including some released by the U.S. Census Bureau from its annual American Community Survey, attesting that certain pandemic measures, particularly those Congress passed, have ushered more people into health insurance than ever before.
In 2021, nearly 299 million Americans had health insurance, the most ever, and the number of Americans without health insurance — just over 28 million in 2021 — had dropped by 1.4 million people from 2019, according to the American Community Survey.
During the pandemic, Congress has prevented states from disenrolling anyone from Medicaid, the health plan for lowerincome Americans. It also increased subsidies to help pay for individual health plans bought on the Affordable Care Act markets.
Yet the increased insurance hasn’t necessarily provided sufficient financial protection and by extension, necessary medical care.
The Affordable Care Act requires insurance plans to provide specified benefits, but it doesn’t eliminate the copays and deductibles that patients must pay.
“The big ‘but’ is that while it’s great that more people have insurance coverage, it’s also half the battle,” said Gideon Lukens, director of research and data analysis for health policy at the leftleaning research institute, the Center on Budget and Policy Priorities. “You still have to make sure people with coverage have access and don’t have to sacrifice their financial security to get it.”
Health policy analysts say Congress and the states can take further steps to fatten the health insurance rolls and protect patients’ financial security.
The Commonwealth Fund survey, which was conducted this year between March 28 and the Fourth of July, interviewed 8,022 adults between ages 18 and 65. It found that 43 percent of working-age adults were inadequately insured.
That means they were either uninsured (9 percent), had a gap in their coverage over the previous year (11 percent) or were insured all year but were “underinsured,” which Commonwealth defines as having coverage that still didn’t provide affordable access to health care (23 percent).
As a consequence, Americans are less healthy than they might be, said Sara Collins, a Commonwealth senior scholar and vice president who co-authored an analysis of the foundation’s findings.
Commonwealth considered a person underinsured if they experienced one of three circumstances:
• Excluding health insurance premiums, an individual during the previous 12 months faced out-of-pocket health expenses amounting to at least 10 percent of the household’s income.
• Out-of-pocket costs apart from premiums over the previous year were at least 5 percent of a household’s income for an individual whose income was under 200 percent of the federal poverty line (in 2022, that is $27,180 for an individual or $55,500 for a family of four).
• The health plan’s deductible requirement constituted 5 percent or more of the household income.
The survey found that more than 4 in 10 people who obtained individual health plans for 2022, including those purchasing plans on the Affordable Care Act marketplaces, were underinsured. But it also reported that nearly 30 percent of those in employer-sponsored health plans fell into the same category.
The survey also found that people with lower incomes were more likely to be underinsured. So, too, were those who considered themselves to be in fair or poor health or who identified themselves as having at least one chronic health condition, such as diabetes or hypertension.