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Many Americans have health insurance that is not “good enough.”

TThe health insurance open enrollment season is gearing up at a time when more people in the United States have health insurance than ever before. Yet millions of Americans who enroll this fall still won’t be able to easily afford the health care they need, or will be hit with medical bills they can’t pay.

Why? Because whether you have health insurance through an employer, the individual market, or even through Medicare, high health care costs and coverage exclusions make insurance less protective every year.

To be sure, being insured is still much better than being uninsured, something that has been known for decades. The Affordable Care Act built on nearly 60 years of progress in expanding insurance coverage. Since the inception of Medicare and Medicaid in 1965, successive, incremental reforms have brought the US to the point where only 8.3% of Americans are now uninsured. While this is higher than any other industrialized country, it proves that political will and steady reforms—the American way—can get us to a better, healthier place.


Such a low rate of uninsured people is worth celebrating. Yet it is also important to ask about the millions who are insured: How good is their health insurance? Unfortunately, the answer for too many Americans is “Not good enough.”

While the ACA created a cap on how much some people have to pay when they get sick, health plans often fail to keep people out of medical debt, provide timely access to the health care they need, or ensure people get the medications they need. can afford what they need. to stay healthy.


In a recent survey conducted by the Commonwealth Fund, which we work for, 40% of working-age adults who were insured for the full year said they had to skip or delay health care they needed because they couldn’t pay for it . Thirty-seven percent had difficulty paying medical bills in the past year or were working to pay off medical debt over time. Among all respondents, 23% were. underinsured, meaning their health care costs and co-payments were especially high compared to their income, and they suffered almost as much as those who were uninsured: 60% reported delays in care due to costs, and 60% of those who did received care, reported difficulty paying their medical bills.

In short, too many Americans are covered by health insurance with such large cost barriers and exclusions that it is coverage in name only. And it’s far from just a problem for people with private insurance: 20% of Medicare enrollees age 65 and older are also underinsured.

The big culprit in all of this is the cost of care. The US is estimated to have spent $4.3 trillion on healthcare in 2021, more than any other country. Why are medical costs higher here than anywhere else in the world? Because medical prices here are higher than anywhere in the world. The prices that commercial insurers and employers pay to providers are directly linked to how much people are asked to pay out of their own pockets in the form of deductibles, copayments and coinsurance because commercial insurers and employers pass a portion of the cost on to consumers. And as long as prices continue to rise unabated, insurers will continue to ask patients to pay more, while also continuing their relentless efforts to deny payment for the care they need.

The US can do better. People who pay premiums for health insurance should be guaranteed affordable care when they or their family members need it.

There are several ways to ensure that health insurance lives up to its promise. First, something needs to be done about how much Americans pay for health care. Lowering costs would actually be the ideal solution, but as a start it might be more practical to just stop them from growing so fast. Coverage also needs to be improved to protect people from high out-of-pocket spending.

Limiting rising prices will require action from several parties. For starters, the federal government should forcefully enforce a current law — one that is largely ignored — that requires hospitals to publish the prices they actually collect from health insurers. Employers cannot be smart shoppers unless they know these prices. Employers must also factor prices into their purchasing decisions. If there is no competition in their health care market, they have a role to play in supporting government efforts to break up local monopolies or regulate prices, such as Maryland’s all-payer model to lower provider prices and Rhode Island’s insurance market regulation to slow down growth. in health care spending. Comprehensive reform in how Americans pay for care — emphasizing value rather than volume — is also key.

Of course cost control will take time and people need help now. Policymakers have several options, especially in the ACA marketplaces. Congress can expand access to care and reduce medical debt by reducing deductibles in marketplace plans and lowering out-of-pocket limits. If temporary premium subsidies in the Inflation Reduction Act are made permanent, many more Americans can afford to stay covered. Adding an out-of-pocket maximum to Medicare would also provide relief to seniors.

The US is in a much better place than when the push to provide meaningful health insurance to all Americans began. Without action from policymakers and industry stakeholders, rising costs will erode these gains and more and more Americans will be stuck with coverage in name only.

David Blumenthal is an internal medicine physician and president of The Commonwealth Fund. Sara Collins is an economist who leads the Commonwealth Fund’s Health Care Coverage and Access Programme. Editor’s note: The Commonwealth Fund funded STAT reporting on racism in health and medicine, as well as ongoing coverage of reproductive health and climate change and health. = function( eventName, parameters ) jQuery.ajax( url: '/wp-json/stat-analytics/v1/facebook-pixel', type: 'POST', data: event_name: !eventName ? null : eventName, parameters: !parameters ? : parameters, source_url: window.location.href , success: function( data, textStatus, jqXHR ) //console.log( data ); , error: function ( jqXHR, textStatus, errorThrown ) //console.log( jqXHR );

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