Beacon Journal/Ohio.com editorial board: Ohioans still without decent health care coverage

With passage of the Affordable Care Act, Congress set up a mechanism for improving lives -- and for making additional improvements to the health care system. The landmark legislation is something better, a work in progress, with flaws and unintended consequences. The shame of the past decade is that Congress has devoted little time to addressing the shortcomings, and some of the regrettable results surfaced Wednesday through a survey of 1,000 Ohioans conducted by Altarum's Healthcare Value Hub.

The study, unveiled by the Universal Health Care Action Network of Ohio, found many people across the state struggling with the cost of health care. For instance, 43 percent of respondents needing care the past year reported cost-driven decision-making about their health. They delayed care, or didn't seek treatment at all. They passed on tests and prescriptions. They rationed medications, going with less than the recommended dosage.

State Rep. Beth Liston, a Dublin Democrat and a physician, put it right: "Our system is set up for them to fail."

Those coping with the reality of care beyond their reach do not get better. Their conditions often get worse, leading to emergency room visits and other more expensive treatment. They may end up receiving care from physicians and facilities outside their insurance network. Soon, a medical bill arrives with a big surprise, the kind of expense that can take years to pay off. This is how health care can turn into bankruptcy.

The Affordable Care Act was designed to prevent such outcomes, if not immediately, then through fine-tuning to fix shortcomings. As it is, many have been helped, gaining access to adequate coverage without ruinous financial outcomes. Subsidies are available to low- and middle-income households. One problem is the subsidies are not sufficient, particularly at the higher income levels of those qualifying. This leads to high deductibles and sketchy coverage, or, in many instances, the unfortunate results found in the survey.

The study discusses potential repairs, such as greater transparency, insurers and providers making available upfront realistic cost estimates. It is reasonable to ease the punitive aspect of out-of-network expenses, especially in emergency situations and when there is little prospect of the patient covering the cost, sooner or later.

It should be easier to switch insurers if your doctor leaves a health plan.

At the same time, larger steps are needed, and they involve improvements to the Affordable Care Act for those who must buy insurance on their own, or do not have coverage through an employer, Medicaid or Medicare. The subsidies available through the online insurance exchange must be more realistic given cost realities, which pose another problem requiring greater attention. In Ohio, the average annual premium for an individual plan has more than doubled the past six years, reaching nearly $6,200 this year.

Fortunately, the state projects an average 7.7 percent reduction in the year ahead. That decrease reflects, in part, insurers having a better grasp of the marketplace. They've been raising prices as a cushion against the uncertainty fueled by congressional inaction and a Trump White House committed to undermining the effectiveness of the exchange, from narrowing the window for signing up to permitting low-cost and lower quality alternatives.

More, the administration has been at the front in the misguided lawsuit seeking to strike down the Affordable Care Act because it no longer includes an individual mandate. Imagine the president and Congress using their time constructively. The act has proved resilient and worthy of upgrading, its combination of market principles and public support involving an intelligent compromise designed to address the problems of many here and elsewhere as they seek what they deserve -- decent health care coverage.

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