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Even Working People With Health Coverage Cannot Afford Care

Four in 10 workers with employer coverage have trouble paying unexpected medical bills or covering out-of-pocket costs.

Four in 10 workers with employer coverage have trouble paying unexpected medical bills or covering out-of-pocket costs.

Millions of people across the United States are struggling to afford health care despite receiving health coverage from an employer, a new survey by the Kaiser Family Foundation and the Los Angeles Times shows. The rising cost of premiums, deductibles and co-pays has outpaced wage growth for more than a decade and has contributed to a growing health care affordability crisis, particularly for those who have chronic health conditions or insurance plans with high deductibles.

The majority of working-age Americans — about 156 million people — have health coverage through a union or employer, but most pay at least a portion of the premium themselves, according to the survey. Even with employer coverage, 4 in 10 workers report trouble paying unexpected medical bills or covering deductibles, co-pays and other out-of-pocket costs. The survey reveals that the health coverage we often associate with full-time employment is not always enough to protect working families from overwhelming health care costs.

Just over half of those with employer insurance say someone in their family postponed needed medical care, rationed or went without medication, or relied on home remedies due to the cost of seeking care. About one in six respondents said they made significant “sacrifices” in order to make health care payments: Two-thirds of those who have trouble making payments reported that they put off vacations or major purchases, or cut spending on food, clothes and household items. Meanwhile, half reported an increase in credit card debt, according to the survey.

From 2008 until 2018, premiums for employer-sponsored insurance plans increased by 55 percent, growing twice as fast as workers’ wages. The size of average deductibles also ballooned by an alarming 212 percent, increasing the amount of money patient must to pay out-of-pocket before the insurance kicks in. In fact, deductibles increased by 4.5 percent in 2018 alone, according to the Kaiser Foundation.

Sara R. Collins, the vice president of health care access at the Commonwealth Fund, an independent health care research group, told the House Rules Committee this week that there are about 44 million working-age Americans who are “underinsured” because they have out-of-pocket costs and deductibles relative to their income. Workers covered by their employers make up the greatest share of the underinsured, but patients who buy their own insurance (including on the Affordable Care Act marketplaces) are more likely to be underinsured. And anyone who is uninsured or underinsured is at risk of falling into medical debt.

“Other research has demonstrated that people who don’t have adequate health insurance all their lives have fundamentally different life experiences and less economic opportunity than those who are adequately insured,” Collins said in her prepared testimony. “This includes lower educational attainment, lifetime earnings and life expectancy.”

Collins testified before a committee hearing billed as “historic” by proponents of the legislation under consideration, the Medicare for All Act of 2019 introduced in the House by Rep. Pramila Jayapal (D-Washington). The bill is popular among progressives, who want to eliminate the need for private insurance plans that require steep deductibles and other cost-sharing features in order to remain profitable by funding a single government plan that can cover everyone.

There are several other proposals for overhauling the health care system before Congress. For instance, a Medicare for All plan with a “public option” — which would retain private insurance as an option for employers and employees — is supported by Rep. Jan Schakowsky of Illinois and other Democrats. Either way, rising health care costs has led to skimpier insurance coverage, Collins said, and federal legislation is need to lower costs for consumers.

“Since the [Affordable Care Act] was passed in 2010, Congress has not passed further legislation that would insure more people or make private plans more affordable or cost-protective,” Collins said.

Indeed, Republicans attempted to “repeal and replace” the Affordable Care Act (ACA) after winning a majority in Congress in 2017, but the move turned out to be a highly unpopular debacle. The ACA initially cut the number of uninsured people in half, but the uninsured rate has remained stable at about 9 to 10 percent ever since, in part because certain red states refuse to expand the Medicaid program for lower-income adults, according to Collins. The underinsured rate nationwide — particularly among working adults with employer-coverage — remains stubbornly high.

With millions of people hurting from deductibles and skipping medical treatment despite contributing to their employer plans, does Medicare for All stand a chance of gaining widespread support? Maybe not. Hardships among those with employer coverage have not necessarily led to widespread discontent: The majority surveyed said they would give their health plan an “A” or “B” grade, with only 24 percent giving a “C” grade or lower.

However, workers with the highest deductible plans were much more likely to give their health plans “C” grades or failing grades altogether. Medicare for All would eliminate most out-of-pocket costs, and would likely be most popular among workers who have seen their wages stagnate while deductibles and health care costs increased. Support for a single-payer system remains steady despite efforts by right-wing politicians to pain the proposal as “socialist” and fiscally irresponsible. Last month, 56 percent of voters supported a single-payer system, according to a Kaiser poll.

The committee hearing this week was the first in the House on the historic Medicare for All legislation, which has little chance of passing during this Congress. Democrats are pushing the bill anyway in order to hammer President Trump and other Republicans on the campaign trail. With more working Americans struggling to pay for health care despite having insurance coverage through their employer, the issue is certain to be on the minds of voters this election season.

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