Health care reform must work for all


Last week officials at the U.S. Department of Health and Human Services announced that an estimated 137 million individuals, including 55 million women and 28 million children now have private health insurance that covers recommended preventive services without cost-sharing as required by the Patient Protection and Affordable Care Act of 2010.

In Pennsylvania that translates to about 6,127,383 individuals, including 2,511,285 women and 1,170,391 children .

“Thanks to the Affordable Care Act, more Pennsylvanians have access to preventive services, including vaccinations, well-baby visits, and diabetes and blood pressure screenings,” said U.S. Secretary of Health and Human Service Sylvia M. Burwell.

Among the preventive services ACA has enabled insured Americans to receive without cost-sharing are annual physicals, immunizations, tobacco cessation interventions and screenings for such conditions as depression, obesity, HIV and cancer.

But what happens when these screenings unveil illnesses?

A recent study by Families USA shows many lower and middle income people who become sick are not seeking treatment because of high deductibles and other cost-sharing imposed by insurance companies.

The study, titled “Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care,”reveals that one out of three lower to middle income adults do not go for medical tests, treatments and follow-up care because they cannot afford the high out-of-pocket costs.

The study addresses those who bought non-group insurance, but the problem also exists for those with group insurance. In recent years, Americans have seen not only their co-pays increase, but they have been saddled with “co-insurance.”

People feel like they are paying to basically have no insurance because of all the costs they must pay in addition to premiums.

“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,” said the report.

The report noted, “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 health costs down the road.”

Utilizing data collected by the Urban Institute’s Health Reform Monitoring Survey, the Families USA report notes that more than half of adults had high deductibles of $1,500 or more, and 30 percent had exceedingly high deductibles of $3,000 or more. Middle-income adults are especially harmed by the high deductibles because they usually do not qualify for cost-sharing subsidies, said Families USA officials.

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

Silver plans are used to calculate premium subsidies under the Affordable Care Act. To help remedy the problem of sick Americans avoiding care because of high out-of-pocket costs despite having insurance, officials at Families USA recommend changes to the silver plans that would lower up-front cost-sharing for primary care, outpatient services and prescription drugs.

Families USA suggests Congress expand the eligibility for cost-sharing subsidies to middle-income consumers with incomes above 250 percent of poverty starting at about $29,200 for an individual or $49,500 or a family of three. Some states have made available the Basic Health Program which uses federal funds to create a plan with lower cost-sharing for low- and middle-income families.

Indeed, for health care reform to encompass all Americans, they should not be burdened with high out-of-pocket expenses after paying for insurance. Preventive care is fine but people do get sick which is when they need health insurance for them the most.

source: daily local

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