Study: One in Four with Year-round Health Insurance Skip Needed Care

WASHINGTON, D.C. — More than one out of four adults (25.2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) 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 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 Healthcare.”

“It is critically important that consumers be able to afford all of these types of care,” the report notes. “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 healthcare costs down the road.”

Lower- to middle-income adults were the most affected, with almost one out of three (32.3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) reporting they skipped needed healthcare 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 explains.

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.

“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 healthcare unaffordable due to high deductibles and other out-of-pocket costs. This needs to be fixed.”

According to the report, over half (50.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) of adults had high deductibles of $1,500 or more, and 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} 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.