When her 14-year-old son, Jaxon, hurt himself playing football, Sa’tori Ananda of Dallas checked out the injury and had to make a tough judgment call: Take him to the doctor and potentially incur massive debt, or ice it and hope for the best. She did the latter. Several days later, they were in the emergency room, where Jaxon was treated for a fracture.
The Affordable Care Act has reduced the number of uninsured Americans significantly, but many insured Americans are making difficult decisions – avoiding or postponing health care because of cost concerns. High deductibles certainly play a role, but so do static incomes that can’t keep up with the rising cost of health care.
According to an October 2014 Associated Press survey of over 1,000 U.S. adults, 1 in 8 privately insured adults under age 65 face ”major financial hardship” due to medical bills. That’s more than 16 million people who may think twice about seeing the doctor when they don’t feel well or getting a costly procedure when their health is on the line.
For Ananda, an engineer consultant for a major telecommunications company, avoiding medical care or prioritizing by cost and necessity is the new normal.
“We used to have more comprehensive coverage through my work’s insurance, but now my deductible is $2,500,” says the mother of three. “Before, we would almost overuse health care, going to the doctor for any ache or illness, but now it’s a different story.”
When Costs Are High, Some Avoid Care
Nineteen percent of privately insured adults don’t go to the doctor when they're sick, according to the AP survey, and higher cost-sharing responsibilities are largely to blame. This is true whether you get your health insurance through a broker, the ACA marketplace or state exchanges, or through your employer.
Deductibles are both more common and higher than ever before. In 2003, only about half of employers offered health care plans with deductibles, and those deductibles averaged around $518. Ten years later, 81 percent of employer-based plans came with a deductible, and the average cost had risen 146 percent to $1,273, according to a trends analysis from The Commonwealth Fund, a foundation that supports health care research. Similar rises were seen in nonemployer-based private health plans, and it’s these deductibles that are often to blame for patient financial hardship.
“What we found was that people who were privately insured who had deductibles that were 5 percent or more of their income delayed or avoided getting needed health care at much higher rates than people whose deductibles were less than 5 percent of their income,” says Sara Collins, vice president of health care coverage and access at The Commonwealth Fund.
The Commonwealth Fund analysis found that nearly one-third of privately insured adults whose deductibles were more than 5 percent of their income skipped a doctor-recommended medical test, treatment or follow-up because of cost.
These people are at the middle to low end of income distribution, Collins says. Some of them may be eligible for Medicaid but are receiving coverage through their employer instead. Many consider themselves within the “middle class,” as Ananda does.
For Jaxon, who plays six sports and is about to enter high school, a recommended foot surgery to correct a “mild deformity” has been placed on the back burner.
“I want to get it done before he enters high school, as it causes him pain and could ultimately affect his sports and potential college scholarships,” Ananda says. “But budgeting for the deductible plus a 20 percent coinsurance isn’t easy.”
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