In the age of Affordable Care Act, now that almost everyone has health insurance, no one has to worry about being crushed by large unplanned medical expenses, right? Not true, according to a new Associated Press survey covered in the Washington Post. The survey found that one out of four respondents with private health care plans worry that they would not be able to afford to pay for an unexpected medical procedure, especially a more serious and expensive one. At issue are high deductible plans, which can leave the insured with high out-of-pocket costs. More:
Such plans already represented a growing share of employer-sponsored coverage. Now, they’re also the mainstay of the new health insurance exchanges created by Obama’s law […]Nineteen percent of all privately insured adults said they did not go to the doctor when they were sick or injured, because of costs. Among those with high-deductible plans, the figure was 29 percent […]Only about half of those surveyed said they had a strong understanding of what their plans cover […]Plan-switchers who said they are paying more outnumbered those who are paying less by 45 percent to 29 percent. Of those paying more, 11 percent said they are getting higher-quality care for their dollar.
The public angst over high deductible plans is a shame. Not only are they good for the health care system as a whole, they can also help consumers make more rational health care decisions. When your insurer or another third-party payer picks up the full tab of your procedure, you’re more likely to consume more health care than is necessary, and you’re less likely to shop for the best price. Study after study has shown that the rise of high deductible plans has contributed to the slowdown in national health care spending.But high deductible plans are only a fix for our system if other reforms are also in place to help bring down costs, educate consumers, and promote price transparency. Without price transparency, for example, high deductible plans are more likely to keep Americans away from medical care altogether, rather than encourage them to shop smartly for it. And the same holds true for consumers who don’t know or aren’t sure about what their plans cover. In isolation, making people pay more of their bill out-of-pocket will bring down costs, but it won’t bring them down enough to make the added out-of-pocket burden tolerable for most.The first “A” in “ACA” stands for “affordable”, but the act does little to solve the problem of cost, which is the problem that matters most to the average consumer. Given that fact, discontent with our health care system will continue to simmer and even occasionally boil over. Liberals will meet that latent discontent with the single payer pivot; conservatives will meet it with a variety of different ideas. But either way, the era of health care reform is just beginning—and we hope that the next round of reform does a better job at attacking the cost problem head on.