Miami Herald (FL)
Aug. 29--More Americans had health
insurance during the first three months of 2017 than before the Affordable Care
Act became law in March 2010, according to the National Health Interview Survey
released Tuesday -- but more have coverage with high out-of-pocket costs, which
can discourage patients from visiting the doctor and filling a prescription.
Healthcare economists say don't blame
the ACA, also known as Obamacare, for the drive toward high-deductible health
plans. That began with December 2003 legislation giving tax breaks for money
that Americans set aside in Health Savings Accounts to pay out-of-pocket
medical expenses.
"It's not like those plans
existed under a current law for a long time and never were popular until the
Affordable Care Act came along," said Paul Fronstin, health research
director for the nonprofit Employee Benefit Research Institute. "They've
been growing slowly and steadily since the day they were introduced in
2004."
Since then, nearly 42 percent of
adults with private coverage or about 58 million Americans have enrolled in
high-deductible plans, according to the national survey published by the CDC's
National Center for Health Statistics.
Steven Ullmann, a healthcare policy
expert with the University of Miami, said employers have seized on
high-deductible health plans as a way to control rising healthcare costs by
shifting more of the financial risk to their workers.
"You're putting decision-making
power more into the hands of the patient-consumer," he said. "If you
are paying more of the price of healthcare, then you're going to be using it
more carefully."
But that strategy can come with
significant risks for workers and employers, Fronstin said.
"People cut back on services
they don't necessarily need," he said. "But they also cut back on
services they do need."
So a diabetic worker who decides to
forgo an eye exam might save on the deductible but later incur the much higher
expense of diabetic retinopathy, which could raise the cost of care for both
employer and employee.
Those most likely to choose a
high-deductible plan are also the least able to afford unexpected medical
costs: low-income Americans. Ullmann said they're more likely to choose
coverage with high out-of-pocket costs because those plans generally have a
lower monthly premium.
According to the national survey,
about half of the estimated 20.5 million Americans who gained coverage under
the ACA did so through their state's expansion of eligibility for Medicaid, the
public health insurance program for low-income and disabled Americans.
Florida is one of 19 states that has
refused to expand Medicaid eligibility under the ACA, leaving an estimated
467,000 adults in the Sunshine State without coverage, according to the Kaiser
Family Foundation, a nonprofit healthcare policy think tank.
The survey, which measures lack of
health insurance, found that about 28.1 million Americans were uninsured during
January to March -- about 500,000 fewer persons than in 2016, and 20.5 million
fewer than in 2010.
Among Americans between 18 and 64,
about 70 percent or 138.8 million have private coverage provided by an employer
or purchased on the individual market, including the ACA exchange at healthcare.gov,
where more than 1.4 million Floridians get their health insurance.
About 19 percent of American adults
younger than 64 had coverage through a public program such as Medicaid, and 12
percent were uninsured, the survey found.
Daniel Chang: 305-376-2012,
@dchangmiami
___
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