Care Delays Raise Stakes in the Healthcare Debate

My daughter was sick last week, with a fever and a sore throat.  She has a history of strep infections, and she thought about going to the doctor and getting checked out.

But her co-pays went up recently, and she was conscious of the cost.  So she checked her own throat in the mirror, decided that she didn’t see any white spots, and stayed home to recuperate on her own.

She’s not the only one treating herself these days.  People are increasingly risking their health by delaying care because of cost – and this isn’t going to change no matter how the Supreme Court rules on the Affordable Care Act.

According to recent data from the Department of Health and Human Services Health System Measurement Project, more than 10% of Americans now report delaying care because of cost.  These include:

• more than 15% of those below 250% of poverty;
• nearly 20% of those with a disability;
• 30% of those already in poor health.

Many delay care because they don’t have insurance.

But here’s the surprise:  the number of privately insured people who delayed seeking needed health care because of the cost increased by more than 50% between 2000 and 2010, from an estimated 8.2 million to almost 13 million. 

Historically, if you had private insurance, like my daughter, then you usually didn’t delay seeking care you might need. 

But in recent years, only children and elders – who have access to strong public insurance programs – haven’t increasingly delayed obtaining care.

There are two reasons why everyone else has.

First, there were 13 million more uninsured people in 2010 than there were in 2000 and 10 million fewer privately insured people.  An uninsured person is six times more likely to delay care because of cost than an insured person. 

Second, even people with private insurance are now more likely to delay care because of rapidly increasing out-of-pocket costs.

This is a natural reaction to paying more for insurance policies that cover less.   

A recent Towers Watson/National Business Group on Health employer survey reported that in 2012 employees will pay an average of $2,764 toward their health insurance premiums – an increase of 9.3% in just one year – and over 34% of their total health care costs after premiums, co-pays, and deductibles are combined.

Meanwhile, insurance policies have become more meager in their coverage.  The biggest area of growth in employer-based health insurance is in high-deductible plans.  Only 2% of companies offered these plans ten years ago.  By next year, 70% will. 

Until recently, most high-deductible plans were offered as one option among several to employees.  In the past two years, however, the percentage of companies offering only high-deductible plans has doubled.    

People with high-deductible plans are among the people we used to call “underinsured.” 

But a high deductible isn’t the only reason to think more people will be delaying care.

According to the US Census Bureau, the percentage of people covered by employer-based private health insurance shrank by almost 9% - to just over half the population – between 2000 and 2010.  And the Towers Watson report found that only 23% of employers are confident that they will be able to offer any health insurance in another ten years, down from 73% who were confident just five years ago.

When your two options are being underinsured or losing your employer-based insurance altogether, you’re not going to feel optimistic about your long-term ability to pay for health care.

What’s more, the Supreme Court decision on the Affordable Care Act probably won’t change this. 

If ACA is upheld, there will be more insurance options available for individuals in beginning 2014, and subsidies to pay for them.  But these may replace employer-based coverage.  Out-of-pocket costs may come down, but only if insurance offerings are rich and prices stay high.

If ACA is struck down, there will be more pressure for insurers to make high deductible plans available to individuals to fill the insurance gap.  This may lower the price of insurance itself, but only if consumers pay more out-of-pocket.

Either way, we consumers are going to be even more motivated in the future to save money by diagnosing and treating our own sore throats.

We’ll risk getting sicker.

And – at a time when we may wish that the health reform issue were finally settled one way or the other – raise the stakes in the next health reform debate.

If you have questions about this column or wish to contact the author, please email gionfriddopaul@gmail.com.