Despite the coverage growth over the last few years, many people still need health insurance. It is because they cannot afford it or cannot get coverage through their employer.
The Affordable Care Act addressed these issues through several reforms, including banning discrimination against individuals with preexisting conditions and expanding Medicaid eligibility to millions of Americans. However, many remain uninsured because of the ACA’s shortcomings and other factors.
Preventive Care
Preventive care is essential for Americans to keep their health and avoid illness, disease or other medical problems. Routine visits for preventive services include screenings, vaccinations, check-ups and patient counseling to help people stay healthy.
High-quality preventive care helps Americans live longer and reduce healthcare costs. Unfortunately, too many uninsured Americans need help accessing these services because of financial barriers.
Insurance coverage for all Americans is essential to ensure everyone can get the preventive care they need, regardless of their income or other circumstances. It will also protect people who cannot afford to pay for these services from going without the medical care they need and ending up in the emergency room.
The Affordable Care Act (ACA) requires that many health insurance plans offer coverage for certain recommended clinical preventive services without cost sharing. This requirement can improve the uptake of services with strong scientific evidence for their health benefits, such as cancer screenings and immunizations.
Several of these preventive services are recommended by multiple groups and are included in comprehensive guidelines supported by HHS and ACIP. They are based on evidence that prevention can lower the risk of death, disability and healthcare spending.
Most commercial health insurance plans must comply with the ACA’s requirements to provide some recommended preventive treatments without charging members of individual, small group, or large group plans. This provision applies to all new programs and excludes grandfathered private plans.
Health Care Costs
Healthcare spending is one of our economy’s largest and most important parts. Additionally, it is among the most expensive regions for individuals to live in.
Healthcare costs in the US are among the highest in the world, and they have been growing more quickly than those in other nations for decades. In 2021, the average person in the United States paid about $12,900 to cover medical costs.
As a result, Americans often find it challenging to get the care they need, even when they are insured. More than 25% of individuals report that they or a family member have skipped dosages, halved tablets, or not filled a prescription due to expense.
In addition, many people are burdened by deductibles and co-insurance. Paying for these costs can be very stressful, especially for families.
Insurance coverage for all Americans will help ensure that people aren’t forced to go without the medical care they need because of the high healthcare costs. It will also help ensure that everyone has access to quality medical care at a price they can afford.
Coverage Gaps
More than half of working-age adults are uninsured, whether or not they have a job. Despite the improvements brought about by the Affordable Treatment Act (ACA), many Americans still require assistance with coverage that is merely nominal or who have significant out-of-pocket expenses and exclusions that limit their ability to obtain treatment in a meaningful way.
Continuous health insurance is associated with higher rates of preventive care and recommended cancer screenings among adults and lower odds of poor self-rated health ratings. In addition, having continuous private coverage is associated with lower odds of work-related health limitations.
Gaps in coverage are often short, but they have significant consequences. People with gaps are less likely to have a regular source of care, less confident in their ability to get care, and more likely to have unmet health needs or untreated conditions.
Young adults are more likely to experience gaps in coverage because of various factors, including aging out of coverage by a parent’s policy or aging out of eligibility for children’s public health insurance. However, recent studies have found that these gaps’ adverse effects persist even after re-establishing insurance.
This analysis estimates that filling the Medicaid coverage gap would meaningfully improve hospitals’ finances in the states that haven’t expanded their programs under the ACA. Hospital margins in these states would increase by $11.9 billion if the program envisioned in the draft Build Back Better Act was entirely in effect in 2023. This improvement would be minor but still substantial if policymakers created a federal Medicaid plan, as envisioned in earlier House reconciliation proposals.
Out-of-Pocket Expenses
While many people are grateful for their health insurance coverage, it doesn’t mean they are never responsible for out-of-pocket expenses. These costs include deductibles, copayments, and other medical expenses not covered or reimbursed by insurance.
Deductibles are the amount a person or family must spend before their health insurance plan begins paying for services. Once a deductible is met, health plans often split the cost of healthcare services with individuals. In most cases, the insurer pays 80% of the price, and the individual pays 20%, known as 80/20 co-insurance.
Another out-of-pocket expense is copayments, a set amount that a person must pay for a doctor’s visit, a trip to the hospital, or a prescription medication fill. Unlike deductibles, however, copayments don’t count toward meeting an annual deductible.
In a survey of insured individuals by the Commonwealth Fund, more than half of patients said they would forgo needed medical care or prescriptions to avoid being hit with punishing out-of-pocket expenses. These costs are why some patients don’t seek care when needed and why more and more Americans are struggling with medical debt.
