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U.S. employer-run health insurance system falls short, survey finds

A new survey by the Commonwealth Fund has found that the US healthcare system is not comprehensive enough, even for those who can get health insurance through their employer.

Based on 6,301 respondents, the Commonwealth Fund found that 29% of those with employer-sponsored health cover and 44% of those with cover in the individual market and ACA markets were under -insured.

“The underlying cost of care is really high,” Matthew Fiedler, principal investigator at the USC-Brookings Schaeffer Initiative for Health Policy, told Yahoo Finance. “So coverage is expensive and employers are finding ways to cut costs…a dollar [an enrollee] spending on health benefits is a dollar they cannot spend on salaries.

The Commonwealth Fund defined a person as underinsured if their outgoings in the previous 12 months, excluding premiums, equaled 10% or more of household income; previous 12-month disbursements, excluding bonuses, equaled 5% or more of household income for those living below 200% of the federal poverty level; or if their deductible was 5% or more of their household income.

Senator Elizabeth Warren speaks about Medicaid expansion during a press conference at the United States Capitol on Sept. 23, 2021. (Photo by Kevin Dietsch/Getty Images)

“Global coverage is at an all-time high, but our report finds that having health insurance isn’t enough to protect millions of Americans from high medical costs that are burdening them with bills they can’t afford. not pay or debts they are working to repay,” David Blumenthal, chairman of the Commonwealth Fund, told reporters on a press call. “The findings highlight how rising health care costs, particularly for inpatient and outpatient services, are burdening Americans whose insurance does not provide adequate financial protection.”

“Underlying care coverage is really high”

Not surprisingly, low-income people with employer-sponsored coverage were underinsured at higher rates than those with higher incomes. Those with health problems were also at higher risk of being underinsured.

“If you’re an employer with a relatively low-income workforce where cash wages are potentially particularly valuable to those enrollees because they’re struggling to make their budget work,” Fiedler said, “those employers can meet the real wishes of their workforces by offering relatively meager health benefits and somewhat higher wages.”

While the Affordable Care Act (ACA), commonly referred to as Obamacare, may seem like a viable alternative, the Commonwealth Fund survey showed that those enrollees are also struggling. Not only were 44% underinsured, but many live in the 12 states that have yet to expand Medicaid, leaving them in the coverage gap without access to affordable, federally subsidized coverage.

The coronavirus pandemic has led to improved market subsidies and helped increase enrollment in both the ACA market and Medicaid. However, many of these policies are temporary and could leave many people uninsured or underinsured once they run out.

“There is still work to be done to cover the remaining uninsured, and there are near-term risks of significant Medicaid enrollment losses at the end of the public health emergency that could drive up the number of uninsured. insured,” Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund, said on the press call. “The survey highlights the biggest coverage challenge in the United States, which is that many people have health insurance that doesn’t provide them with timely access to health care and economic security.”

Driving up medical debt

These flaws in the healthcare system are some of the driving factors behind the growing problem of medical debt in the United States.

According to the Consumer Financial Protection Bureau (CFPB), in June 2021, Americans held $88 billion in medical debt on their consumer credit records, with most individual debt under $500. Medical debt is the most common debt collection at 58%, followed by telecommunications at just 15%.

“When we talk about medical debt, we’re talking about uninsured people,” Fiedler said. “But certainly some people who are insured, some people who are on a plan with a large deductible, may need care and then find they can’t pay their deductible.”

For those with employer-sponsored health coverage, the average deductible was $1,434 in 2021, while the maximum outgoing was $4,272 on average. People on market plans paid an average of $2,825 for deductibles and up to $8,700 for out-of-pocket expenses.

The survey also found that half of respondents wouldn’t have the money to cover an unexpected $1,000 medical bill in the next 30 days, with even higher numbers for communities of color: 69% for black adults and 63% for Latino/Hispanic adults.

“The cost problem in the United States is endemic, long-standing and incredibly difficult to solve,” Collins said. “It’s special in the United States.”

Collins proposed two possible solutions: price regulation and price-lowering competition.

“We have no evidence yet that consumers choose care based on price, even when they are underinsured,” she said. “They tend not to shop by price, but nonetheless, there’s a lot of momentum behind the idea and the observation that there’s a huge consolidation on the vendor side among hospitals and among systems. .”

Adriana Belmonte is a reporter and editor and covers politics and health care politics for Yahoo Finance. You can follow her on Twitter @adrianambells and contact her at adriana@yahoofinance.com.

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