Over the past few years, millions of Americans have gotten health insurance coverage through the state and federal exchanges mandated by the Patient Protection and Affordable Care Act. However, more recently a number of experts have come forward to say that they have concerns about whether the plans many of those Americans are buying actually makes it affordable to get health care when they need it, and as premiums rise, this seems to be growing into an even greater concern.
For instance, the "silver" plans that the vast majority of people signing up for coverage through the ACA exchanges will typically cover about 70 percent of the cost of care, according to a report from John Geyman, professor emeritus of family medicine at the University of Washington School of Medicine. And while that's obviously a large chunk of those costs, for the low-income consumers who rely on ACA coverage, even 30 percent left over can be a crippling impediment to actually being able to afford whatever treatments may be necessary in their lives.
In addition to this, it seems that some health insurers are finding ways around certain rules in the health care law, and therefore are shifting more costs back onto the consumer in other ways, the report said. These methods include limiting access through benefit designs, restricted drug formularies, making out of network care prohibitively expensive or simply not covering it at all, narrowing the definitions of what is medically necessary, and so on. This may be particularly true when it comes to treating mental health, which is still a major issue for millions of Americans to deal with every day.
In addition, it's not as though premiums have stopped increasing, the report said. Instead, they're increasing more slowly on a national level - averaging about 7.5 percent for coverage in 2016 - but on a more granular basis the spikes can be massive. For instance, one insurer in North Carolina was recently approved for a rate hike of 35 percent. This may be especially problematic because many Healthcare.gov customers already report premiums are difficult for them to afford.
What else is going wrong?
Meanwhile, many low-income Americans are still also buying coverage that comes with low premiums but huge deductibles, which is another issue that prevents people from seeking care, the report said. Further, many of those policyholders are also in a difficult position when it comes to obtaining care because these plans also limit the number of doctors they can see in their areas, often giving them access to somewhere between just 10 percent and 25 percent of physicians in their areas.
These are serious issues that health insurers may need to address, lest they run into problems related to getting these Americans enrolled and in compliance with federal law. The more that can be done to help people understand their coverage and help them find a plan that works for all involved, the better off everyone is going to be.