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Just because patients have health insurance doesn’t mean they can afford healthcare.
Joseph Betancourt, primary care doctor and president of nonprofit health policy research firm the Commonwealth Fund, sees this “firsthand.”
“I regularly care for patients who struggle to afford essential medications, battle denied claims for the care they need,” he said during a November 20 press conference.
The Commonwealth Fund’s 2024 biennial health insurance survey, released November 21, found that though 79% of US adults had continuous health insurance for 12 months, 23% were underinsured, meaning they have health insurance and still can’t afford care. About 56% of those surveyed had adequate insurance coverage all year.
Betancourt said the Affordable Care Act (ACA) and ACA marketplace subsidy expansions have helped many previously underinsured patients get coverage. An estimated 8% (26 million people) of the US population was uninsured in 2023, compared to 16% (49 million) in 2010 before the ACA took effect, according to a national CDC survey. However, there is still more work to do to increase access.
The underinsured
The study analyzed 6,400 adults ages 19 to 65 who were polled from March through June.
The study labeled someone “underinsured” if their annual out-of-pocket costs were 10% or more of their income—5% if their income was less than 200% of the 2023 federal poverty level—or their deductible was 5% or more of their income.
The analysis didn’t include premiums.
Of those who were underinsured, 44% said they were paying off medical or dental debt, and 57% said they “avoided getting needed healthcare because of its cost,” the survey found.
For those with debt, 48% owed $2,000 or more. About half the time, the debt came from treating a chronic health condition.
The survey found that most of the underinsured respondents were also on employer plans (66%) with high deductibles or out-of-pocket costs, Sara Collins, the Commonwealth Fund’s senior scholar and VP for healthcare coverage and access, said at the conference.
The uninsured
The survey also found 9% of respondents were uninsured and 12% saw a gap in coverage over a 12-month period.
Patients may not be aware of their options, Betancourt said at the conference.
“The devil’s in the details: a lot of fine print. It is increasingly, I think, complicated for [patients] just to take advantage of the types of things that they’re eligible for,” Betancourt said.
The nonpartisan Congressional Budget Office estimated that in 2023, 15.2 million people who were uninsured qualified for subsidized coverage.
Collins pointed to potential policy reforms to reduce the number of uninsured and underinsured adults, ranging from auto-enrollment to permanently extending the enhanced marketplace premium tax credits set to expire in 2025. She also pushed for efforts to curb the rising cost of healthcare.
“Healthcare cost growth is at the source of affordability problems reported by people in the survey. It will take effort by private and public payers, providers, and policymakers to slow,” she said.