On Nov. 21, leaders at The Commonwealth Fund, the New York Metropolis-based public-interest basis, launched their newest report on the medical health insurance protection of shoppers, a biennial report referred to as “The State of U.S. Well being Insurance coverage in 2024: Findings from the Commonwealth Fund Biennial Well being Insurance coverage Survey.” The report reveals main challenges round medical health insurance protection for People, together with the important thing difficulty of underinsurance.
The Commonwealth Fund’s press launch, posted to the group’s web site on Thursday morning, started thus: “The Reasonably priced Care Act (ACA) and up to date reductions in market premiums have introduced U.S. uninsured charges to document lows, with most working-age People lined all year long. Nevertheless, a brand new Commonwealth Fund survey exhibits that protection gaps stay, and well being plans — together with these provided by employers, which cowl most individuals — don’t all the time assure inexpensive or well timed entry to care. The report suggests methods policymakers can broaden protection and decrease prices for shoppers.”
On behalf of The Commonwealth Fund, SSRS, a survey firm, interviewed 8,200 adults aged 19 to 64, and Commonwealth Fund consultants analyzed 6,400 survey responses. Based mostly on their evaluation, Commonwealth Fund leaders wee in a position to decide that 23 p.c of survey respondents with insurance coverage protection have been underinsured—which they outlined as “enrolled in well being plans with excessive out-of-pocket prices that make it tough to afford care. Amongst these underinsured,” the Commonwealth Fund famous, “two-thirds (66 p.c) had protection via an employer, 14 p.c had particular person or market plans, and 11 p.c have been enrolled in Medicaid. Greater than half (57 p.c) reported forgoing care due to value and 44 p.c mentioned they carry medical debt.”
There have been quite a few key findings, amongst them the next
Ø Two-thirds of underinsured adults—66 p.c—are lined via an employer-based well being plan.
Ø Greater than half of adults who have been uninsured or underinsured reported skipping really useful therapies or not filling prescriptions as a consequence of value.
Ø As much as one-third of individuals with a power situation, corresponding to coronary heart failure and diabetes, selected to not fill prescriptions for his or her well being circumstances as a consequence of value.
Ø Over one-third of working-age adults who have been uninsured or underinsured are paying off medical or dental debt, forcing many to delay or keep away from needed care, forgo important wants, and expertise stress.
Ø Practically half (48 p.c) of all adults with medical debt owe $2,000 or extra; one in all 5 (21percent) carry a staggering $5,000 or extra in debt.
Ø About half (51 p.c) of adults with debt mentioned it stemmed from therapy they obtained for an ongoing well being situation; hospital care was cited as essentially the most frequent supply of debt (49 p.c).
Ø Delaying or skipping care is harming individuals’s well being. Two of 5 adults (41 p.c) who skipped or delayed wanted care due to the fee mentioned their well being downside has worsened in consequence. This was very true for individuals who have been experiencing poor well being and had decrease incomes (45 p.c).
Joseph R. Betancourt, M.D., M.P.H., president of The Commonwealth Fund, made an announcement on the outset of a press briefing held on-line on Wednesday, Nov. 19, previous to the official launch of the survey outcomes. “Our biennial medical health insurance survey gives a broad take a look at People’ experiences with medical health insurance, together with the standard of their protection,” Dr. Betancourt mentioned. “What it reveals is a important weak point within the U.S. medical health insurance system: even with protection, too many People are nonetheless struggling to afford the care they want. We discover ourselves in a novel second in 2024. Because of the Reasonably priced Care Act, and up to date expansions in premium subsidies for market plans, extra People have protection than ever earlier than; the uninsured price is at a historic low. Individuals with preexisting circumstances can entry protection with out discrimination, and preventative care is out there without charge. These are very actual and vital achievements. Nevertheless, having medical health insurance doesn’t all the time imply entry to inexpensive, well timed care.”
Certainly, Betancourt mentioned, “Our findings underscore how the excessive value of protection throughout nearly all of insurance policy is impacting individuals each day. And with so many insured People dealing with such excessive out-of-pocket prices and deductibles, they’re being compelled to tackle medical debt and even skip wanted care altogether. I’ll say this isn’t only a healthcare difficulty, it’s an financial one; when individuals are compelled to spend a good portion of their earnings on healthcare with out sufficient safety, they’ve usually pushed into debt and compelled to decide on between their well being and monetary safety. Personally, as a major care physician, I see first-hand how these important protection gaps aren’t simply nationwide knowledge factors; they’re impacting particular person lives. I often take care of sufferers who wrestle to afford important drugs, battle denied claims for the care they want; I see older sufferers who needed to cope with this over time, and since they didn’t have sufficient protection earlier than Medicare, are actually sicker, and value our healthcare system extra due to it. Trying forward, particularly as we face a brand new Congress and administration, we hope these findings assist advance clear coverage options to handle these challenges and the lived experiences of hundreds of thousands of People.”
The report was authored by Sara R. Collins, Ph.D., senior scholar and vp for healthcare protection and entry, and Avni Gupta, Ph.D., researcher for healthcare protection and entry, each at The Commonwealth Fund.
The press launch notes that “Coverage choices that might convey higher protection to extra individuals embody:
Ø Completely lengthen enhanced market premium tax credit, launched through the COVID pandemic, that are set to run out in 2025. With out these credit, annual premium prices for shoppers in market plans will spike by a mean $705 and an estimated 4 million might lose protection.
Ø Take away medical debt from credit score studies and implement stronger necessities on hospitals to stop sufferers from accumulating debt.
Ø Decrease deductibles and out-of-pocket prices in market plans.
Ø Regulate premiums and value sharing in employer plans based mostly on employees’ incomes to make protection extra inexpensive and complete for lower-wage workers.
Ø Set up a federal fallback choice to cowl the estimated 1.5 million uninsured individuals within the 10 states that haven’t expanded their Medicaid packages.
Ø Enable states to keep up steady Medicaid eligibility for adults for 12 months — as has been finished for kids in Medicaid and the Kids’s Well being Insurance coverage Program. This might assist forestall lapses in protection due to eligibility modifications, administrative errors, and different elements that may go away individuals uninsured and unable to get care.”
The complete report will be accessed right here.
As defined on the group’s web site, “The Commonwealth Fund was established in 1918 with the broad cost to boost the widespread good. Its founder, Anna M. Harkness, is among the many first ladies to begin a non-public basis. At the moment, the mission of the Commonwealth Fund is to advertise a high-performing, equitable well being care system that achieves higher entry, improved high quality, and larger effectivity, significantly for society’s most susceptible, together with individuals of colour, individuals with low earnings, and those that are uninsured. The Fund carries out this mandate by supporting impartial analysis on well being care points and making grants to enhance well being care apply and coverage. A world program in well being coverage is designed to stimulate modern insurance policies and practices in america and different industrialized international locations.”
