Millions of Americans have health insurance that isn’t ‘adequate’

T.The new health insurance season is about to begin at a time when more people than ever have health insurance in the United States. Yet the millions of Americans entering school this fall still won’t get in easily. provide the healthcare you need Or they’ll be hit with medical bills they can’t afford.

why? Whether you have health insurance through your employer, the private market, or Medicare, your insurance protection is getting lower each year due to high medical costs and coverage exclusions.

Sure, having insurance has been known for decades, but it’s so much better than not having it. The Affordable Care Act builds on nearly 60 years of his progress in expanding insurance coverage.start with Medicare and Medicaid started in 1965through successive and incremental reforms, the United States is currently only 8.3% of Americans are uninsured. higher than that other developed countriesit proves that political will and steady reform – the American way – can lead us to a better, healthier place.


Such a low uninsured rate is commendable. But it’s also important to ask about the millions of people who have insurance. How good is their health insurance? Unfortunately, the answer for too many Americans is “not good enough.”

The ACA put limits on how much some people have to pay when they get sick, but health insurance is designed to keep people out of medical bills and to get them timely access to the care they need. It is often not possible to provide adequate access or ensure that people can afford the medicines they need. to stay healthy.


and Recent research A study conducted by the Commonwealth Foundation, where we work, found that 40% of working-age adults with one year of insurance skip or postpone essential medical services because they are unable to pay for them. said there is a need. Thirty-seven percent were struggling to pay their medical bills in the past year or were slowly paying off their medical bills.23% of all respondents underThat is, their medical bills and deductibles were particularly high compared to their income, and they suffered almost as much as uninsured people paying their medical bills.

In short, too many Americans are covered by health insurance, with too many cost barriers and exclusions, covered only in name. Not a problem, 20% of Medicare participants over the age of 65 are underinsured.

The main cause of all this is the cost of care.US expected to spend $4.3 trillion Health care share in 2021 is higher than any other country. Why is healthcare here more expensive than anywhere else in the world? Because healthcare is more expensive here than anywhere else in the world. The price that commercial insurers and employers pay providers is directly related to the amount people are asked to pay out of their own pocket in the form of deductibles, copayments and co-insurance. This is because commercial insurers and employers pass on some of the costs to consumers. And as long as prices continue to rise unabated, insurance companies will continue to demand more from patients.

America can do better. People who pay for health insurance should be guaranteed affordable care for themselves or their families when they need it.

There are several ways to ensure your health insurance is working as promised. First and foremost, something must be done about how much Americans pay for health care. While actually lowering costs is the ideal solution, it may be more realistic to stop costs from rising too quickly in the first place. Coverage also needs to be improved to protect people from large out-of-pocket costs.

Controlling price increases requires multi-stakeholder action. First, the federal government should aggressively enforce the current (and largely ignored) law that requires hospitals to publish the prices they actually collect from health insurance companies. Without knowing these prices, an employer cannot be a smart buyer. Employers should also factor price into their purchasing decisions. In the absence of competition in the healthcare market, they play a role in supporting government efforts to break territorial monopolies and regulate prices, as in Maryland. Full payment model to lower provider prices Rhode Island insurance market regulation To slow the growth of medical costs. It’s also important to comprehensively reform the way Americans pay for health care, focusing on value over quantity.

Of course, cost control takes time and people need help now. The policymaker has several options, especially in his ACA market. Congress can expand access to health care and reduce health care debt by reducing market plan deductibles and lowering out-of-pocket limits.If Temporary premium subsidy Because the Inflation Reduction Act made insurance permanent, more Americans could afford to stay covered. Adding a co-payment cap to Medicare will also reduce the burden on older people.

The United States is in a much better place than it was when the move to provide meaningful health coverage for all Americans began. Without action from policy makers and industry stakeholders, rising costs will erode these benefits and more and more Americans will be stuck with coverage in name only.

David Blumenthal is a physician and president of The Commonwealth Fund. Sara Collins is an economist who leads the Commonwealth Fund’s Health Coverage and Access Program. Editor’s note: The Commonwealth Fund provides grants for STAT reports on racism in health and medicine, as well as ongoing coverage of reproductive health and climate change and health.

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