More Are Insured Under ACA, But Have More Out-Of-Pocket Costs

Aug. 29--More Americans had health insurance during the first three months of 2017 than before the Affordable Care Act became law in March 2010, according to the National Health Interview Survey released Tuesday -- but more have coverage with high out-of-pocket costs, which can discourage patients from visiting the doctor and filling a prescription.

Healthcare economists say don't blame the ACA, also known as Obamacare, for the drive toward high-deductible health plans. That began with December 2003 legislation giving tax breaks for money that Americans set aside in Health Savings Accounts to pay out-of-pocket medical expenses.

"It's not like those plans existed under a current law for a long time and never were popular until the Affordable Care Act came along," said Paul Fronstin, health research director for the nonprofit Employee Benefit Research Institute. "They've been growing slowly and steadily since the day they were introduced in 2004."

Since then, nearly 42 percent of adults with private coverage or about 58 million Americans have enrolled in high-deductible plans, according to the national survey published by the CDC's National Center for Health Statistics.

Steven Ullmann, a healthcare policy expert with the University of Miami, said employers have seized on high-deductible health plans as a way to control rising healthcare costs by shifting more of the financial risk to their workers.

"You're putting decision-making power more into the hands of the patient-consumer," he said. "If you are paying more of the price of healthcare, then you're going to be using it more carefully."

But that strategy can come with significant risks for workers and employers, Fronstin said.

"People cut back on services they don't necessarily need," he said. "But they also cut back on services they do need."

So a diabetic worker who decides to forgo an eye exam might save on the deductible but later incur the much higher expense of diabetic retinopathy, which could raise the cost of care for both employer and employee.

Those most likely to choose a high-deductible plan are also the least able to afford unexpected medical costs: low-income Americans. Ullmann said they're more likely to choose coverage with high out-of-pocket costs because those plans generally have a lower monthly premium.

According to the national survey, about half of the estimated 20.5 million Americans who gained coverage under the ACA did so through their state's expansion of eligibility for Medicaid, the public health insurance program for low-income and disabled Americans.

Florida is one of 19 states that has refused to expand Medicaid eligibility under the ACA, leaving an estimated 467,000 adults in the Sunshine State without coverage, according to the Kaiser Family Foundation, a nonprofit healthcare policy think tank.

The survey, which measures lack of health insurance, found that about 28.1 million Americans were uninsured during January to March -- about 500,000 fewer persons than in 2016, and 20.5 million fewer than in 2010.

Among Americans between 18 and 64, about 70 percent or 138.8 million have private coverage provided by an employer or purchased on the individual market, including the ACA exchange at healthcare.gov, where more than 1.4 million Floridians get their health insurance.

About 19 percent of American adults younger than 64 had coverage through a public program such as Medicaid, and 12 percent were uninsured, the survey found.

Daniel Chang: 305-376-2012, @dchangmiami

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