Drew Altman, Kaiser
Family Foundation Aug 20, 2018
Data: Kaiser Family Foundation; Chart: Chris
Canipe/Axios
We still have
an uninsured problem in the U.S., but we have a far broader health care
affordability problem that hits sick people especially hard.
Why it
matters: It's time to think more broadly about who's having trouble
paying for the health care they need. The combination of lack of insurance and
affordability affects about a quarter of the non-elderly population at any one
time, but almost half of people who are sick.
Now that the
Affordable Care Act has expanded health coverage, the percentage of the
non-elderly population that is uninsured is now just under 11%, the lowest
level ever recorded. But as the chart shows:
- Another 15.5% who have
insurance either skipped or delayed care because of the cost or reported
that they or someone in their family faced problems paying their bills in
2017.
- That brings the total percentage of
non-elderly people with insurance and affordability problems to 26.2%.
More striking:
nearly half of all people in fair or poor health — 46.4% —
are uninsured or have affordability problems despite having coverage.
- That includes 13.5% who were uninsured and
in fair or poor health — arguably the worst off in the entire system — and
another 32.9% percent who have insurance but said they or a family member
have had a problem affording care in the last year.
It’s not
surprising that people who are sicker and need more care would have
more problems paying for it. But arguably an insurance system should work best
for people who need it the most.
All this says a
lot about current health care politics.
- It helps explain why so
many people name health their top issue, despite the
progress that has been made in covering the uninsured. And everyone who's
sick and can't afford medical care has family members and friends who see
what they are going through, creating a political multiplier effect.
- It is also why health care is
substantially an economic issue as well as an issue of access to care.
When people have trouble paying medical bills, it's a hard hit to their
family budgets — causing many people to take a second job, roll up more
debt, borrow money, and forego other important family needs.
For as long as
I have been in the field, we have used two measures more than any others to
gauge the performance of the health system: the number of Americans who are
uninsured and the percentage of GDP we spend on health. Both measures remain
valid today.
The bottom
line: If we want a measure that captures how people perceive the
system when the number of uninsured is down and overall health spending has
moderated, we need better ways of counting up the much larger share of the
population who are having problems affording care.
And whatever
big policy idea candidates are selling, from single payer on the left to health
care choices on the right, the candidate who connects that idea to the public’s
worries about paying their medical bills is the one who will have found the secret
sauce.
https://www.axios.com/not-just-uninsured-cost-of-health-care-cdcb4c02-0864-4e64-b745-efbe5b4b7efc.html?utm_campaign=KFF-2018-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=65384568&_hsenc=p2ANqtz--S3QmC58QZF1w5JdIGkuQWA4lA2ZsGx03eiPrZqUyeuh01jFWsEGpO3Im2dLHHe7Mu9-LGhJ5rlvTBmLCMkJpZlWI9_A&_hsmi=65384568
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