Obamacare Hasn’t Cured People’s Anxiety About Medical Costs

Americans still are worried about whether they can afford their medical bills.

Americans are still concerned about medical costs. (Shutterstock/zimmytws)
National Journal
May 20, 2015, 11 p.m.

Mil­lions of Amer­ic­ans have en­rolled in private health cov­er­age through the Af­ford­able Care Act in its first two years, but a lot of them still are wor­ried about big med­ic­al bills.

Nearly 4 in 10 Amer­ic­ans who en­rolled in an ACA-com­pli­ant in­di­vidu­al health in­sur­ance plan in 2015—both on and off of Obama­care’s mar­ket­places—said they still felt vul­ner­able to high med­ic­al costs, ac­cord­ing to a new sur­vey from the Kais­er Fam­ily Found­a­tion.

Mar­ket­place en­rollees were gen­er­ally pos­it­ive about their in­sur­ance—74 per­cent rated their plan ex­cel­lent or good—but cost re­mains a con­cern for a sig­ni­fic­ant minor­ity of them. For ex­ample: 36 per­cent said they were dis­sat­is­fied with their an­nu­al de­duct­ible. And 56 per­cent of people with Obama­care-com­pli­ant plans said they were very or some­what wor­ried about their abil­ity to pay the health care ser­vices they need.

A big prob­lem: Plans that tend to have the low­est monthly premi­ums also have the highest de­duct­ibles. Al­most 90 per­cent of 2015 Obama­care en­rollees signed up for either a bronze-level or sil­ver-level plan, the cheapest cov­er­age but which can have de­duct­ibles of thou­sands of dol­lars. That means people can still be on the hook for a good chunk of change if they ac­tu­ally rack up med­ic­al bills.

About 40 per­cent of those in the over­all in­di­vidu­al mar­ket were en­rolled in high-de­duct­ible plans—which Kais­er defined as above $1,500 for an in­di­vidu­al or $3,000 for a fam­ily—versus 43 per­cent in low-de­duct­ible plans. (The rest wer­en’t sure). Just 35 per­cent of those in the high-de­duct­ible plans were happy with their de­duct­ible; 79 per­cent of low-de­duct­ible en­rollees were.

“The trend to­wards high de­duct­ibles pred­ated the Af­ford­able Care Act, but the health law in some sense le­git­im­ized them by de­fin­ing what is min­im­ally ad­equate in­sur­ance,” said Larry Levitt, vice pres­id­ent at the Kais­er Fam­ily Found­a­tion.

“The ACA says that the min­im­um in­sur­ance you need to have to sat­is­fy the in­di­vidu­al man­date is a bronze plan, which has a de­duct­ible of sev­er­al thou­sand dol­lars per per­son. So, the ACA is say­ing that high de­duct­ible in­sur­ance is ac­cept­able,” Levitt ad­ded. “Even sil­ver plans, which are the bench­mark for premi­um sub­sidies un­der the ACA, gen­er­ally carry a de­duct­ible of at least a couple thou­sand dol­lars per per­son.

Or an­oth­er way to look at it: More than 85 per­cent of mar­ket­place en­rollees qual­i­fied for fin­an­cial as­sist­ance, which means their in­come was 400 per­cent of the fed­er­al poverty level or be­low. That’s $47,000 for an in­di­vidu­al or $97,000 for a fam­ily of four. Obama­care capped total out-of-pock­et ex­penses (which in­cludes de­duct­ibles, co­pays, etc.) for mar­ket­place plans at $6,600 for an in­di­vidu­al and $13,200 for a fam­ily.

So even with a re­l­at­ively middle-class an­nu­al in­come, med­ic­al bills up­wards of $5,000 that one could face with an Obama­care plan are a lot to swal­low. And the lower you go down the in­come scale, the harder it gets.

The law does have nu­mer­ous pro­vi­sions to help people af­ford their cov­er­age and care: The tax cred­its to help cov­er premi­ums and ad­di­tion­al cost-shar­ing sub­sidies for those with the low­est in­comes, the out-of-pock­et caps, elim­in­at­ing an­nu­al and life­time lim­its on what in­surers will pay for care. It’s also helped a lot of people af­ford in­sur­ance for the first time.

But the Kais­er find­ings make clear that people are still wor­ried it isn’t enough.

“Many people with non-group in­sur­ance feel fin­an­cially ex­posed to high med­ic­al bills, and that’s es­pe­cially true for those with big de­duct­ibles,” Levitt said. “Many people just don’t have the sav­ings to cush­ion them in an emer­gency, even if they have in­sur­ance.”

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