By Larry Hausner
Special to the Herald Times
RBC | Of all their concerns about healthcare, Americans are most worried about whether they can afford their insurance. That’s the key finding from a new Morning Consult survey of more than 20,000 people.
It’s easy to see why Americans are so anxious. Premiums are set to rise sharply next year. And insurers are shifting more of the cost of procedures and medicines onto patients. In short, people are paying more but getting less coverage. In many cases, patients appear to be skipping needed treatments because they can’t afford their copays or co-insurance.
Unaffordable insurance is a problem for the nation, not just for individual households. If people don’t have quality coverage, they’ll be stuck with ineffective treatments. Their conditions can worsen—causing their healthcare costs to balloon.
Rising premiums are crushing family budgets across the nation. More than four out of ten Americans said that their monthly health insurance premiums increased in the past year. Come 2017, insurers will increase premiums for employer-sponsored plans about 5 percent. For Americans who buy coverage on the Affordable Care Act exchanges, premiums will skyrocket 25 percent, on average. Consumers in many states could see their premiums increase 60 percent or more.
Insurers are making patients shoulder a larger share of treatment costs. Four out of 10 Americans say that their out of pocket costs have spiked in the past few years, according to the survey. As of 2014, Americans were spending more than triple on their deductibles than they had a decade prior, according to the Kaiser Family Foundation.
In exchange for the added costs, Americans are receiving less coverage.
Insurers increasingly exclude some providers from networks to squeeze big discounts out of the remaining in-network doctors and hospitals. As a result, four in ten consumers had trouble, or knew somebody who had trouble, finding an in-network doctor or clinic.
Recently I had a medical issue that required surgery. The cost of the out-of-network surgeon was $18,000. The insurance company refused to pay the doctor’s charge for the surgery. After three long and tedious rounds of appeals, an outside arbitrator deemed that the surgery should be covered since it was an emergency situation. The insurance company paid the surgeon its previously negotiated in-network fee of $179.47. The number of in-network doctors, and thus patient’s choices, is shrinking.
Firms are also dragging their feet or flat out refusing to pay for certain therapies. Nearly 30 percent of Americans report that their doctor prescribed them a treatment that wasn’t covered by insurers. A similar percentage experienced difficulty getting an insurer to cover a needed treatment.
The thinning coverage and bulked up costs mean that healthcare is, in practice, inaccessible for many people, even though they technically have insurance coverage. A majority of Americans either couldn’t fill a prescription, or know someone who couldn’t, because the cost-sharing requirement was too high.
Consider the story one doctor recently shared about his patient suffering from ulcerative colitis, a chronic disease that causes inflammation in the large intestine. The doctor had prescribed the 28-year-old woman two medications that got her colitis under control.
But a year later, the woman returned to his office, crying. She was sicker than before. The doctor asked if the medicines had stopped working. She then revealed that she had quit taking them because her insurance company stopped covering the drugs, and she couldn’t afford the out of pocket costs.
Going without treatment is bad for patients—and for the nation’s healthcare budget. Nearly 60 percent of the population suffers from at least one chronic disease. Preventing and managing these diseases is vastly cheaper than letting them spiral out of control.
Chronic diseases are already projected to cost us $42 trillion from now until 2030. If insurance quality continues to decline and more patients can’t adhere to their treatments, the bill could grow even larger.
Reforms to lower insurance costs and ensure quality coverage would enable patients to better manage their chronic diseases. That would spare them from needless suffering—and the nation from needless healthcare expenditures.
In the current political climate, it is difficult to see quick resolution to this not insurmountable problem. However, amending Obamacare—as was always anticipated by the administration—could resolve the issues.
For millions of Americans, good insurance is a prerequisite for good health. No wonder people are so concerned about their worsening coverage.
Larry Hausner is chief patient advocate of the Partnership to Fight Chronic Disease.
