EBRI Finds Spike In Health Care Access Problems

Consumers with private health insurance generally like their health coverage, but they say they are having a harder time getting medical appointments.

Consumers with high-deductible coverage and no health savings account (HSA) or health reimbursement arrangement (HRA) are especially likely to report appointment-setting problems.

Paul Fronstin, an analyst at the Employee Benefit Research Institute (EBRI), and Anne Elmlinger, an analyst at Greenwald & Associates, have published appoint access data in a summary of results of an Internet survey of about 2,000 adults ages 21 to 64 who had private health coverage.

The survey team conducted the interviews in August 2014.

The sample included people who had employer-sponsored coverage, and it also included people who bought their own individual coverage, either through a Patient Protection and Affordable Care Act (PPACA) exchange or through the off-exchange market.

The analysts divided the participants into three groups: those who have traditional low-deductible coverage, or coverage with an individual deductible under $1,250, or a family deductible under $2,500; enrollees in high-deductible health plans (HDHPs), or those with high-deductible plans and no access to HSAs or HRAs; and members of account-based health plans, or those with high deductibles and access to HSAs or HRAs.

The survey participants were about as likely to say they were very or extremely satisfied with their coverage in 2014 as in 2013. The percentage who were satisfied increased to 61 percent, from 58 percent, for traditional coverage holders; fell slightly, to 37 percent, from 38 percent, to HDHP users; and increased slightly, to 46 percent, from 45 percent, for users of account-based plans.

But the analysts found that participants' satisfaction with ease of getting doctor appointments fell between 2012 and 2014, and plummeted for HDHP users:

66 percent of the traditional coverage users were satisfied in 2014, down from 67 percent in 2013, and down from 71 percent in 2012.

65 percent of the account-based plan users were satisfied in 2014, down from 66 percent in 2013, and down from 71 percent in 2012.

54 percent of HDHP users were satisfied in 2014, down from 63 percent in 2013, and down from 66 percent in 2012.

The drop in satisfaction among HDHP users "may have been related to the increasing number of narrow-network plans on public exchanges," the analysts write.

About one-fifth of the HDHP users had individual coverage, compared with fewer than 10 percent of the employer plan enrollees, and differences between individual coverage and employer coverage may be responsible for some of the gap in access satisfaction, the analysts say.