Study Finds Chronically Ill Will Be Underinsured in Exchanges

Victims of several chronic diseases wait outside the Supreme Court building for the start of the session on March 5, 2008 in Brasilia. Brazil's Federal Supreme Court will decide today on the continuity of the embryonic stem cells research, after Roman Catholich church officials and anti-abortion groups urged to ban it, as the stem cells extraction entails the destruction of the embryo.
National Journal
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Clara Ritger
Dec. 5, 2013, 6:05 a.m.

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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