The American health insurance system is expensive, actively antagonizes patients, and leaves millions of people without access to coverage — and, as a new poll shows, is often dysfunctional even for the majority of people who have an insurance plan.
According to a new nationally representative survey of 3,605 people with health coverage released by KFF on Thursday, roughly 6 in 10 adults with health insurance report having had a problem with their health insurance coverage over the past year, with those with employer-provided insurance, rather than marketplace or government run insurance, reporting issues at the highest rate.
If the data is representative of the American population, it means that likely tens of millions — if not well over 100 million — of the roughly 300 million people with health insurance in the U.S. have had issues with health insurance coverage recently.
Top issues include insurance not paying out as much as expected (27 percent), not being able to see an in-network doctor due to a lack of appointments (26 percent), insurance not covering a prescribed drug or requiring a very high copay (23 percent), or insurance not covering care a patient thought was covered (18 percent). Other common issues were also related to denial of coverage, like having prior approval denied or delayed; needing to see a doctor, go to a hospital or get mental health care that wasn’t covered; or reaching the limit on visits their plan would pay for.
In a further indictment of the system, those who have needed more care were the most likely to have had a problem with their health insurance. Of people who have had more than 10 provider visits in the past year, nearly 8 in 10, or 78 percent, reported having a problem with their insurance. People who needed mental health treatment were also more likely to have problems, with 74 percent running into an issue — and 43 percent saying that they have forgone care, likely as a result of poor coverage.
Insurance plans are also often difficult to understand, with a majority (51 percent) of insured adults saying they have issues understanding at least one aspect of their health insurance, like what their plan covers or how much they will pay out of pocket for care.
“The survey shows that the sheer complexity of insurance is as big a problem as affordability, particularly for those with the greatest needs,” said KFF president and CEO Drew Altman. “People report an obstacle course of claims denials, limited in-network providers, and a labyrinth of red tape, with many saying it prevented them from getting needed care.”
Experts and progressive advocates have long been saying that the health care system in the U.S. is broken — often by design. Private health insurers frequently work behind the scenes to deny claims with clear merit or have strange and unpredictable gaps in coverage that leave patients strapped with huge medical bills, like when a patient goes to a hospital to see a doctor who’s covered by their plan — but is seen in a facility that isn’t. Meanwhile, people who have no insurance, perhaps due to a sudden firing or lay off, are constantly on the edge of financial precarity or are being forced to forgo care due to cost.
The American health care system thus creates the worst health outcomes in most aspects of any wealthy country in the world, while also being the most expensive system of any wealthy country in the world, as the U.S. is the only wealthy country without universal health care. According to a February Commonwealth Fund report, the U.S. spent over $10,600 per capita on health care in 2021 — nearly double the per capita spending of the country with the next-highest costs.
But, despite the ineffectiveness of the current system, catching up to the rest of the U.S.’s peers and implementing universal health care seems to be out of the question for Congress and federal lawmakers, as the huge amount of money invested in lobbying against Medicare for All practically constitutes an entire industry of its own.
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