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Study Finds Chronically Ill Will Be Underinsured in Exchanges Study Finds Chronically Ill Will Be Underinsured in Exchanges

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Health Care

Study Finds Chronically Ill Will Be Underinsured in Exchanges

Victims of several chronic diseases wait outside the Supreme Court building. While the Affordable Care Act will help access to services, Avalere Health found that not enough is being done in terms of affordability.(EVARISTO SA/AFP/Getty Images)

photo of Clara Ritger
December 5, 2013

Chronically ill patients will face significant medical expenses on the Obamacare exchanges, a study finds.

Out-of-pocket caps are designed to limit the total cost a patient faces in his or her health care, but for people with advanced medical conditions requiring expensive treatment and prescriptions, the caps are not enough.

Avalere Health, a health consulting firm, found that for someone who earns about 200 percent of the federal poverty line, their maximum contribution is 23 percent of their total income. For someone earning 100 percent of the federal poverty line, they'll pay up to 20 percent.

 

That amount greatly exceeds the Commonwealth Fund definition of underinsurance, which is defined as patients contributing more than 10 percent of their total income. The Commonwealth Fund is a private, New-York based health services company.

"Patients with high health care needs will benefit the most from new out-of-pocket caps, but they will still face considerable expenses before they reach the cap. These costs could result in inadequate or inconsistent care for high-need, low-income exchange enrollees," said Caroline Pearson, vice president at Avalere Health, in a press release.

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