One-third of U.S. adults paying more out of pocket

February 1, 2011

Adults in the United States are more likely than those in 10 other countries to forgo healthcare due to costs

NATIONAL REPORTS-A recent 11-country survey conducted by the Commonwealth Fund found that adults in the United States are more likely than those in 10 other countries to forgo healthcare due to costs. They also report they have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover their insurance wouldn't pay as they expected.

According to the study's authors, the findings suggest a need for the Patient Protection and Affordable Care Act (PPACA) reforms that will ensure access to healthcare, protect people from medical debt, and simplify health insurance.

"The Affordable Care Act establishes state health insurance exchanges for small employers and individuals without employer or public coverage," says Sara Collins, vice president, affordable health insurance, the Commonwealth Fund. "People buying insurance on their own will have far better information about what health plans cover than they do today. Through the exchange, employers and individuals will be able to choose among plans that have a federally determined 'essential benefit package' comparable to employer-sponsored plans."

In addition, both uninsured and insured U.S. adults reported high out-of-pocket rates. One-third reported paying $1,000 or more in out-of-pocket expenses in the past year.

Likewise, U.S. adults with lower incomes were also more likely than those with above average incomes to report difficulties in paying their medical bills as well as receiving timely access to healthcare. Nearly half of lower income adults went without needed care, and one-third had a bill problem, which were double the rates that above average income adults with insurance reported.

COMPLEX INSURANCE SYSTEM

According to the study, a significant percentage (31%) of U.S. adults said they spent a lot of time dealing with insurance paperwork, had their insurer deny a claim, or had their insurer pay less than anticipated. In addition, adults under age 65 were most likely to have problems dealing with providers.

Given such difficulties, there certainly seems to be a need for a more simplified insurance market. Collins suggests that better information about health insurance can encourage consumers to buy coverage, but another important feature of the health insurance exchanges will be affordability.

"For the first time, people buying coverage on their own will have access to a premium subsidy," Collins says. "Premium credits will be tied to the silver plan sold through the exchange and will cap premium contributions for individuals and families to about 3% of income."

Also, subsidized private coverage has the potential to provide health insurance for up to 44% of those currently uninsured, or 20 million people, she says. Other gains be attributed to the new insurance market rules against underwriting on the basis of health, limits on age rating and the elimination of pre-existing condition exclusions.

According to the study's authors, U.S. health insurance performance should improve over time due to expansions under the health reform. However, out-of-pocket spending is expected to remain high compared with other countries. Affordability provisions may also need to be strengthened.

Last month, the Congressional Budget Office said a repeal of PPACA would increase the federal deficit between 2012 and 2019 by approximately $145 billion. Constitutional challenges to some provisions in the law remain unsolved.