qotd: Private health plans no longer assure adequate protection

The Associated Press-NORC Center for Public Affairs Research
October 2014
Privately Insured in America: Opinions on Health Care Costs and Coverage

A significant minority of those with private health insurance, including
those covered by high-deductible health plans (HDHPs), are greatly
impacted by the out-of-pocket cost of health care—they are concerned
with the uncertainty of major expenses, skip necessary medical
treatment, and experience real financial burden when obtaining health
care. All told, about 1 in 8 privately insured Americans—or more than 16
million people—face major financial hardships like going without food or
using up all of their savings as a result of medical bills.

When asked about nine specific behaviors to reduce personal health care
expenses, about half of privately insured adults age 18-64 experienced
at least one of them.

* As a result of health care costs, significant minorities of privately
insured individuals don't go to the doctor when they are sick (19
percent), go without preventive and recommended care (18 percent), use
up all or most of their savings (18 percent), and go without basic needs
(13 percent).

* A quarter of privately insured adults age 18-64 lack confidence in
their ability to pay for a major unexpected medical expense.

* The privately insured who report having a HDHP are more likely than
those who do not to decrease their contributions to savings (41 percent
vs. 26 percent) and retirement plans (28 percent vs. 15 percent) as a
result of health care costs.

* Nearly 1 in 4 adults age 18-64 covered by a HDHP reports that paying
for health care expenses caused them to use up their savings.

* Thirty-five percent of those surveyed indicate that when enrolling in
a health insurance plan, their current plan was the only option available.

* With out-of-pocket costs emerging as a major source of uncertainty
among the privately insured, more privately insured Americans choose a
health care plan with a relatively high monthly premium but lower
out-of-pocket costs (52 percent) over a plan with relatively low
premiums and higher out-of-pocket costs (40 percent), when presented
with the tradeoff.

* But, there isn't overwhelming support for plans with select networks5
designed to keep out-of-pocket costs low. Twenty percent say they are
extremely or very willing to
participate in this type of plan, 38 percent are somewhat willing, and
40 percent are not too or not at all willing.

Of those who indicate they have used health care services since
enrolling in their current health insurance plan, 39 percent say the
out-of-pocket costs being higher than expected has been a major (14
percent) or a minor (24 percent) problem.

As the health care marketplace is evolving with the advent of new
exchanges, those who purchase their health insurance plans directly or
through exchanges are more likely to express difficulty finding health
care providers covered under their plans.

Those who have changed health insurance plans and say they have HDHPs
are especially likely to cite increased costs without a corresponding
increase in quality.

http://www.apnorc.org/PDFs/Coverage/AP-NORC-Opinions%20on%20Health%20Care%20Costs%20and%20Coverage_FINAL%20web%20(1).pdf

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Comment by Don McCanne

This new survey conducted by the Associated Press-NORC Center for Public
Affairs Research confirms, once again, that private health insurance in
the United States often is not providing adequate financial protection
for those with health care needs. More than 16 million people who have
private insurance "face major financial hardships like going without
food or using up all of their savings as a result of medical bills." The
one-half of Americans who use hardly any health care at all likely do
not realize that they are one major illness away from similar financial
hardship.

When something is not working, we should fix it. The inadequacies of
private plans cannot be repaired without intolerable increases in health
insurance premiums. Yet a well designed single payer national health
program could remove the financial barriers to care - for everyone -
without any increase in our current national health expenditures.
Without action, 30 million will remain without any insurance at all, and
many of the rest of us could remain vulnerable to high out-of-pocket
medical costs in spite of our private insurance coverage.