Healthcare reform is not done. Not by a long shot. While Obamacare has gone a very long way toward getting people insured
, and in creating some good reforms and regulations on private insurance, private health insurance can still be pretty sucky. And according to a new report
from the Commonwealth Fund it's pretty sucky for nearly a quarter of the population which has private insurance.
The Commonwealth Fund counts adults as underinsured if they meet one of two conditions: their out-of-pocket costs totaled 10 percent or more of their income or if their deductible was 5 percent or more of total income. And they found that 23 percent of Americans with insurance fit into this category—up from 12 percent in 2003.
Underinsurance matters because it appears to deter people from seeking care. Underinsured people are far more likely to not go to the doctor when they have a medical problem; a quarter of the underinsured report doing this, compared with 12 percent of those with more robust coverage. They skip prescriptions, follow-up tests, and specialist visits at a rate that's inching closer to the uninsured —people with no coverage at all.
That's a very large group of people and they have been hit very hard
financially: "47 percent of respondents said they exhausted their savings to pay medical bills, 23 percent were dealing with collection agencies and 7 percent had to declare bankruptcy." The major problem is deductibles, which just keep growing.
That chart shows the shrinking number of health plans that don't include deductibles—from 40 percent in 2003 to 25 percent in 2014 at the same time that deductibles are growing. Now more than in 10 people with private insurance has a deductible of $3,000 or more, up from just 1 percent in 2003. Wages and salaries are not keeping up with those increases, and in fact employee compensation has largely stagnated because health insurance costs are growing so fast for employers.
It does help that Obamacare includes essential benefits, including basic physical exams, cancer screenings, etc. But if one of those screenings requires specialized care, or follow-up testing or expensive prescriptions, co-pays and deductibles can put that follow-up care in jeopardy for too many people—44 percent in this study. That's how many "reported not getting needed care because of cost in the past year, including not going to the doctor when sick, not filling a prescription, skipping a test or treatment recommended by a doctor, or not seeing a specialist."
Having health insurance is better than not having health insurance. But if you can't afford to actually use that insurance without risking financial disaster, then it's clearly not much of a safety net. These costs have to come down. The best way yet demonstrated for healthcare spending to be controlled is through single-payer systems. So healthcare reform in this country is going to have to take the next step and expand Medicare.