The PJ Tatler

Obamacare Deductibles Forcing Patients to Forgo Preventive Care

One notable problem with Obamacare insurance policies that has been commented on extensively is the higher-than-average deductibles that make seeking routine health care an expensive proposition.

In fact, according to this New York Times story, the sky-high deductibles — double what many consumers carried in their old policies — is preventing them from getting preventive care that could lead to serious health issues later.

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network. But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.

While high-deductible plans cover most of the costs of severe illnesses and lengthy hospital stays, protecting against catastrophic debt, those plans may compel people to forgo routine care that could prevent bigger, longer-term health issues, according to experts and research.

“They will cause some people to not get care they should get,” Katherine Hempstead, who directs research on health insurance coverage at the Robert Wood Johnson Foundation, said of high-deductible marketplace plans. “Unfortunately, the people who are attracted to the lower premiums tend to be the ones who are going to have the most trouble coming up with all the cost-sharing if in fact they want to use their health insurance.”

Deductibles for the most popular health plans sold through the new marketplaces are higher than those commonly found in employer-sponsored health plans, according to Margaret A. Nowak, the research director of Breakaway Policy Strategies, a health care consulting company. A survey by the Kaiser Family Foundation found that the average deductible for individual coverage in employer-sponsored plans was $1,217 this year.

In comparison, the average deductible for a bronze plan on the exchange — the least expensive coverage — was $5,081 for an individual and $10,386 for a family, according to HealthPocket, a consulting firm. Silver plans, which were the most popular option this year, had average deductibles of $2,907 for an individual and $6,078 for a family.

One of the advantages of having a health savings account is that routine checkups and the occasional health care expense can be paid for out of pocket. This allows a consumer to carry a higher deductible which usually means a lower monthly premium.

But most Americans don’t have a health savings account, which means it’s prohibitively expensive for many consumers to have to pay out of pocket for MRIs, X-rays, and other diagnostic tools that are routinely used in medical examinations. Obamacare forces consumers to carry a higher deductible, preventing them from getting care when early detection for many illnesses is vital.

In short, there is little practical difference between having no insurance, and having an Obamacare insurance policy. What good is insurance if you can’t use it?

Of course, if you get seriously ill, that Obamacare policy comes in handy. And there are also limits on out-of-pocket expenses in Obamacare policies that means the consumer probably won’t go bankrupt paying for health services.

But for most healthy Americans, a hospital stay is the least of their worries. What matters is being able to diagnose and treat illnesses/conditions that may come up during the course of a year. Not being able to get proper care because their insurance deductible is so high that seeing a doctor is out of the question presents another in a long list of unintended consequences that Obamacare has given us.