Many Americans Have Health Insurance That’s Not “Good Enough”


Jhe health insurance open enrollment season is brewing at a time when more people in the United States have health insurance than ever before. Yet millions of Americans who enroll this fall will still not be able to easily afford the health care they need or will be hit with medical bills they cannot pay.

Why? Because whether you have health insurance through an employer, the individual market, or even through Medicare, high health care costs and coverage exclusions make insurance less protective every year.

Certainly, being insured is always much better than not being insured, which has been known for decades. The Affordable Care Act builds on nearly 60 years of progress in expanding insurance coverage. Beginning with the creation of Medicare and Medicaid in 1965, successive, incremental reforms have brought the United States to the point where only 8.3% of Americans are uninsured. Although this is higher than in any other industrialized country, it proves that political will and constant reform – the American way – can get us to a better and healthier place.


Such a low rate of uninsured people is worth celebrating. However, is it also important to ask questions about the millions of policyholders: what is the quality of their health insurance? Unfortunately, the answer for too many Americans is “Not good enough.”

While the ACA has created a limit on how much some people have to pay when they get sick, health plans often fail to avoid medical debt, provide timely access to the health care they need, or ensure that people can afford the medicines they need. to stay healthy.


In a recent survey by the Commonwealth Fund, which we work for, 40% of working-age adults who had year-round insurance said they had to skip or delay the healthcare they needed because they couldn’t afford them. Thirty-seven percent have struggled to pay their medical bills in the past year or have paid off their medical debts over time. Of all respondents, 23% were belowinsured, meaning their healthcare costs and deductibles were particularly high relative to their income, and they suffered almost as much as those who were uninsured: 60% reported delays in care in cost, and 60% of those who received care reported problems paying their medical bills.

In short, too many Americans are covered by health insurance with cost barriers and exclusions so enormous that it is only nominal coverage. And it’s not just a problem for people with private insurance: 20% of Medicare enrollees age 65 and older are also underinsured.

The main culprit in all of this is the cost of care. The United States is expected to have spent $4.3 trillion on health care in 2021, more than any other country. Why are medical costs higher here than anywhere in the world? Because medical prices are higher here than anywhere in the world. The prices that commercial insurers and employers pay providers are directly related to how much people are asked to pay out of pocket in the form of deductibles, co-payments and coinsurance, as commercial insurers and employers pass on a portion costs on consumers. And as long as prices continue to rise unabated, insurers will continue to ask patients to pay more, while continuing their strenuous efforts to deny payment for the care they need.

The United States can do better. People who pay health insurance premiums should be guaranteed affordable care when they or their family members need it.

There are several ways to ensure that health insurance delivers on its promises. First and foremost, something needs to be done to find out how much Americans pay for health care. In fact, cutting costs would be the ideal solution but, to start with, it may be more practical to prevent them from growing so quickly. Coverage also needs to be improved to protect people against high out-of-pocket expenses.

To curb rising prices, several parties will need to act. For starters, the federal government should vigorously enforce a current — largely ignored — law that requires hospitals to publish the prices they actually collect from health insurers. Employers cannot be informed buyers if they do not know these prices. Employers must also consider price in their purchasing decisions. If there is no competition in their health care market, they have a role to play in supporting government efforts to break up local monopolies or regulate prices, such as the all payers model of the Maryland to reduce provider prices and regulation of the Rhode Island insurance market to slow growth. in health spending. Comprehensive reform of how Americans pay for care — to emphasize value rather than volume — is also essential.

Of course, cost control will take time and people need help now. Policy makers have several options, especially in ACA markets. Congress could expand access to care and reduce medical debt by reducing deductibles in market plans and lowering their reimbursement limits. If the temporary premium subsidies provided for in the Cut Inflation Act became permanent, many more Americans could afford to stay covered. Adding an out-of-pocket maximum to Medicare would also bring relief to the elderly.

The United States is far better off than when the push began to provide all Americans with meaningful health insurance. Without action from policymakers and industry stakeholders, rising costs will reduce these gains and more Americans will be stuck with name-only coverage.

David Blumenthal is an internist and chairman of the Commonwealth Fund. Sara Collins is an economist who runs the Commonwealth Fund’s Healthcare Access and Coverage Programme. Editor’s note: The Commonwealth Fund has funded STAT reports on racism in health and medicine, as well as ongoing coverage of reproductive health, climate change and health.


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