Reforms to ACA Silver Plans Recommended at Federal and State Levels
High Deductible Plans are Associated with Skipped Tests and Treatments
More than one out of four adults (25.2%) who bought non-group health insurance last year went without needed care because they could not afford it – and high deductibles of $1,500 or more seem to be the leading cause for the missed care, according to a report issued today by Families USA.
Medical tests, treatments and follow-up care were the most common types of care adults skipped, according to the report, titled “Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care.”
“It is critically important that consumers be able to afford all of these types of care,” the report said. “Not getting follow up care to treat an illness or not taking needed medications can result in people facing avoidable, more serious health problems and more expensive health care costs down the road.”
Lower- to middle-income adults were the most affected, with almost one out of three (32.3%) reporting they skipped needed health care because they couldn’t afford it.
“Our findings show that too many lower- and middle-income consumers face deductibles that are likely unaffordable relative to their incomes and that could create barriers to them getting the care they need,” the report said.
The report recommends changes to the silver plans that would lower upfront cost sharing for primary care, outpatient services and prescription drugs. Silver plans are used to calculate premium subsidies under the Affordable Care Act. Six state-based marketplaces and the District of Columbia have already done this and provide models to follow.
States and the federal government should also increase levels of assistance provided. Minnesota, for instance, has established a Basic Health Program – an option available under the ACA – which used federal funds to create a plan with lower cost-sharing for low- and middle-income families. Also, Congress should expand the eligibility for cost-sharing subsidies to middle-income consumers with incomes above 250 percent of poverty – starting at about 29,200 for an individual or $49,500 or a family of three.
“The Affordable Care Act is a huge, historic success in expanding health coverage,” said Ron Pollack, executive director of Families USA. “More than 14 million previously uninsured Americans gained health coverage in the past two years. But gaining health coverage too often still leaves needed health care unaffordable due to high deductibles and other out-of-pocket costs. This needs to be fixed.”
According to the report, over half (50.6%) of adults had high deductibles of $1,500 or more, and 30 percent had exceedingly high deductibles of $3,000 or more. The high deductibles are especially harmful for middle-income adults because they do not qualify for cost-sharing subsidies through the ACA.
Other finding in the report include:
• The proportion of lower- to middle-income adults enrolled in non-group plans jumped from 25 percent in 2013 to nearly 37 percent in 2014 – the first year subsidized insurance was available through the ACA.
• The number of adults in the non-group market with no deductible nearly tripled from 3.6 percent in 2013 to 10.6 percent in 2014.
• Adults who bought their insurance in the marketplace were less likely to have high deductibles of $1,500 or more or more – about 43 percent versus nearly 60 percent among those who bought their insurance outside of the marketplace.
• Adults who bought their insurance in the market place were also less likely to have exceedingly high deductibles of $3,000 or more – 22.5 percent versus 37.5 percent outside of the marketplace.
• Because most adults in the non-group market do not have dental care as part of their health coverage, the ability to see a dentist was not included in the main body of this report. But when dental care is added to the mix, it becomes the most common type of care adults forgo because they cannot afford it. Nearly 24 percent reported not getting needed dental care and this underscores the need to address this crucial gap in coverage.
The numbers in this report come from data collected by the Urban Institute’s Health Reform Monitoring Survey in September 2013, September 2014 and December 2014.