The long-term effects of current health insurance

In recent years, many Americans have come to recognize that the current health insurance system can cause major problems for consumers. Between costs, network complications and more, a large percentage of people who have strong coverage options may not do all they can to keep themselves healthy when they're in need of medical attention. More concerning is that this problem seems to be getting worse.

From 1998 to 2017, the number of people across the U.S. between the ages of 18 and 64 who say they've been unable to see a doctor due to the expected cost increased by nearly 34%, according to a study recently published in the Journal of the American Medical Association – Internal Medicine. Indeed, the percentage of Americans who said they fell into this category grew to 15.7% from the 11.4% seen 20 years earlier.

In all, that share grew despite the fact that rates of uninsurance fell to about 1 in 7 (14.8%) from roughly 1 in 6 (16.9%) in the same time, the study found. As one might expect, this issue was particularly pervasive for people who don't have insurance (rising to almost 2 in 5 from fewer than 1 in 3, an increase of about 20%), but the problem grew even more sharply for people who did have insurance (from 7.1% to 11.5%, proportional growth of more than 60%).

There were also sharp increases of these types observed for people with a number of serious, chronic illnesses, including cardiovascular disease, high cholesterol and substance abuse issues.

Consumers remain concerned about the cost of coverage.

Big differences
Meanwhile, a recent survey from National Public Radio, the Robert Wood Johnson Foundation and Harvard University found that while only 1 in 20 people who have incomes in the top 1% of earners have run into difficulty with medical costs, that wasn't the case for lower-earning workers. The Income Inequality Report showed that almost 1 in 3 people with middling incomes faced financial hardships when it comes to dealing with medical costs, and that was true for close to 2 in 5 people in the lowest-earning ranks. These numbers do not include people who decided to forego treatment due to the perceived costs, only those who had actually sought health care.

Indeed, 31% of the lowest-earning group (those making less than $35,000 annually) say they've had “serious problems” getting health care when they needed it, compared with 26% of middle-income people making less than $100,000 but more than the previous group, the survey found. Similar percentages in these groups felt they faced difficulties getting quality care, or had problems trying to cover the cost of prescription drugs. Indeed, 30% of lowest earners and 23% of middling earners said they have either avoided filling prescriptions or cut back on their dosages to save money.

This was most often the case when insurance refused to pay for prescription drug; 76% of adults earning the lowest incomes avoided paying for such medicines out of pocket, and that was also the case for 85% of those making middling incomes, the survey found.

What does the future hold?
With prices for care, coverage and drugs on the rise, an analysis by Wharton found that these issues could significantly worsen in the years ahead under current health care laws. For instance, the rate of uninsurance could nearly triple over the next 40 years, hitting as high as 27%. Currently, the number is about 10%, but would hit 20% by 2040, and continue rising in a more or less straight line from 2028 through 2060.

Consequently, the analysis projects that the share of the overall population who goes without coverage will follow a similar – if less linear – path. While it estimates that only about 4.5% of Americans forego treatment due to the cost, that number would likely rise to the low-12% range by the mid-2050s and remain at that highly elevated level for some time after. The current rate would likely double as soon as 2033, and hit double digits just five years later.

Seeing the need
With all these health care-related cost pressures impacting Americans today, it should come as no surprise that many want more action to be taken at a federal level, according to a recent Kaiser Family Foundation survey. Approximately 87% of those polled said they think it's very important for Congress to act on lowering prescription prices, and nearly as many felt the same way about ensuring the protections in the Affordable Care Act remain in place for people with pre-existing conditions.

These are all issues for the insurance industry to monitor, but it's also vitally important to reach out to policyholders to make sure they know what they're paying for, and what they can do to get the best possible care at a price they can afford.