The NYT has a piece entitled “Insured, but Not Covered”—and the title says it all. The piece does a deep dive on some of the ways Americans who count as officially insured nevertheless do not have coverage that works well for them, either because it sticks them with large out-of-pocket costs or because it makes it hard for them to see a provider. Though the law, the article argues, has removed “some of the more egregious” financial burdens the U.S. health care system put on consumers, many remain:
By endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.
“I’m always curious when I read this ‘good news’ that health costs are moderating, because my health care costs go up significantly each year, and I think that’s a common experience,” said Mark Rukavina, president of Community Health Advisors in Massachusetts.
While much of the focus in the past has been on keeping premiums manageable, “premiums now tell only a part of the story,” Mr. Rukavina said, adding: “A big part of the way they’ve kept premiums down is to shift costs to patients in the form of co-pays and deductibles and other types of out-of-pocket expenses. And that can leave patients very vulnerable.”
Even while cost continues to be a big issue for many Americans, the Times notes that the ACA has increased barriers to access in a different way. Since new plans created by the law came on line, users are having a hard time figuring out which providers are covered and which aren’t, sometimes requiring patients to find new insurance in the middle of treatment or while in other tight spots. Once you realize that expanding coverage does not always, in practice, create good health care you can double down on the idea of federal reforms or you can opt to create conditions in which consumers have more control over their own experience. We prefer the latter, but either way you cannot point to top-line insurance statistics and declare victory for the ACA.