President Obama on Tuesday kicked off what’s being described as a weeks-long campaign to bring attention to the ways the Affordable Care Act is working for individuals and families. So let’s look at one key test that could determine how the law is working.
Should the new health insurance exchanges succeed in providing coverage to some 30 million Americans, one of the benchmarks for success would be whether sick Americans actually receive the care they need. Absent universal healthcare – which the U.S. will not have even after Obamacare is fully implemented – this is one of the most contentious side issues of the health care debate.
According to a recent survey by the Commonwealth Fund, a health care think tank, "U.S. adults are significantly more likely than their counterparts to forgo health care because of the cost, to have difficulty paying for care even when they have insurance, and to deal with time-consuming insurance issues."
This may not be good news for policymakers and proponents of Obamacare. There's little to suggest that the exchanges will reduce overall health care costs, trim paperwork or make insurance claim processing any easier.
The Commonwealth Fund, which routinely studies health care in the U.S. and throughout the world, found that complexity in private insurance probably isn't going away. The researchers also found that:
- In 2013, more than one-third (37 percent) of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared with as few as 4 percent to 6 percent in the United Kingdom and Sweden.
- Roughly 40 percent of both insured and uninsured U.S. respondents spent $1,000 or more out-of-pocket during the year on medical care, not counting premiums. High deductibles and cost-sharing, along with no limits on out-of-pocket costs, may explain why even insured people in the U.S. struggled to afford needed health care, the researchers said.
- Nearly one-quarter (23 percent) of U.S. adults either had serious problems paying medical bills or were unable to pay them, compared with fewer than 13 percent of adults in the next-highest country, France, and 6 percent or fewer in the U.K., Sweden and Norway.
- About one in three (32 percent) U.S. adults spent a lot of time dealing with insurance paperwork and disputes or were either denied payment for a claim or received less than expected.
Can the cost of insurance paper shuffling be partially driving the high cost of care in the U.S? There is a connection, since U.S. insurers paid $606 per person in administrative costs – more than twice the amount than in the next-highest country. Keep in mind that money spent on processing claims is not spent on things like preventive or acute care.
Since the Affordable Care Act keeps – and expands – the private insurance market, the inefficiency of running a fragmented system will remain. Those who can buy an affordable policy will still have to deal with out-of-pocket costs, provider networks and uncovered care.
Access to care and private coverage under the ACA is not to be confused with reining in costs.
In the U.S., according to Commonwealth, $8,508 is spent per person on health care. "That is nearly $3,000 more per person than Norway, the second-highest spender," the researchers found.
Americans, however, will still need to make decisions as to when and how to seek health care. For those with the lowest ACA premium plans in the "catastrophic" and "bronze" categories, for example, some 20 percent of their costs will be uncovered by insurance. Will they choose to forgo emergency room visits that fall under their deductible? Will they skimp on routine care for chronic conditions like diabetes? How will it impact their health over time if they are avoiding care that will prevent future complications?
Before anyone in Washington does the big picture analysis, though – which will take years – state and federal officials still have a few bugs to work out. Oregon's health exchange, for example, doesn't seem to be working at all. The federal HealthCare.gov site is gradually improving, although it's not known if applicants can connect with insurers, who need a set of data files called an 834 EDI transmission, with items like payment information.
Although these systems can be fixed over time, we’ll then have to see if those who sign up will ultimately get the coverage they need to tackle the most serious conditions they face. Over time, we may look back on the technical woes as a trivial issue compared to how Americans eventually obtain – or don't obtain – the care they need.
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