Why is affordable health care important

If you will remember, President Obama signed the health care reform law on March 23, Things got off to a rocky start when the online enrollment for health insurance was difficult to navigate. Although polarizing, the ACA has extended health insurance coverage to millions of uninsured Americans and provided all Americans with health insurance consumer protections.

It has been a lifeline for many of our patients. And, by reducing the skyrocketing demand for uncompensated care, it has helped ensure the economic vitality of Genesis and many health systems. Affordability—or unaffordability—has to look at all three.

The problem of unaffordability is most apparent for the nearly 47 million Americans who lack health insurance. Most people without health insurance are workers or live in families with a worker, but do not have health coverage through an employer.

Sadly, even people who actually have health insurance increasingly face affordability problems when it comes to paying for health care. Research documents that a growing number of Americans with health insurance face affordability problems for health insurance and for health care.

Researchers define affordability in a number of ways. One set focuses on medical spending as a share of income, characterizing families that exceed specified thresholds as economically threatened or underinsured. For example, a recent analysis by the Commonwealth Fund identified families as underinsured if they had out-of-pocket medical spending that absorbed at least 10 percent of family income, or, for low-income adults defined as percent of the federal poverty level , at least 5 percent of family income; or if they faced deductibles of at least 5 percent of family income.

Using these tests, the study identified 25 million adults who had health coverage as underinsured in —a percent increase from the According to the Center for Studying Health System Change, one in seven Americans under age 65 reported problems paying medical bills in —a figure that jumped to one in five Americans by This analysis indicates that even moderate levels of out-of-pocket spending relative to family income—that is, spending that is well below the 5 or 10 percent of family income considered to be underinsured by the studies just cited—created medical bill problems.

For example, two-thirds of the individuals who reported trouble paying medical bills spent 5 percent or less of their family income on health care.

And even a relatively low level of health care spending compared to family income can create financial stress for low-income families. Medicaid and CHIP, established to provide special protection for low-income and modest income families, do not necessarily prevent these problems.

First, no matter how low their incomes, working-aged adults who are not parents of dependent children or are not disabled are not eligible for Medicaid except in states with waivers , and, in many states, parents earning the minimum wage have too much income to qualify for Medicaid protection. The traditional Medicaid program limits cost-sharing responsibilities to nominal deductibles and copayments for most services, and exempts children, pregnant women, and other vulnerable groups from service-related cost-sharing.

The CHIP program, which typically serves children with somewhat higher—although still modest—incomes also utilizes a 5 percent of income cap on aggregate cost-sharing. The risk of being underinsured or experiencing financial problems due to health spending varies not only by family income but also by health status.

Health care affordability is particularly elusive for individuals with chronic illness and other conditions that require ongoing, often costly, medical care.

In particular, individuals who are older, have an activity limitation, have a chronic condition such as diabetes, heart disease, or arthritis, or have experienced stroke, are more likely to spend a high proportion of their income on health expenses. See chart next page. Medicaid expansion has helped many disabled people and caregivers access care based on their income status.

Not all disabled people qualify for the traditional Medicaid disability pathway. Medicaid expansion allows disabled people to join the workforce without jeopardizing their Medicaid benefits and gives low-income workers a fallback option for coverage if they lose access to employer-sponsored insurance.

Essential health benefits help disabled people access necessary services. Prior to the ACA, 45 percent of individual market plans did not cover SUD services and 38 percent did not cover mental health care.

Following ACA implementation, people with mental health conditions became significantly less likely to report unmet need due to cost of mental health care. The ACA has helped millions of Americans gain insurance coverage, saved thousands of lives, and strengthened the health care system.

The law has been life-changing for people who were previously uninsured, have lower incomes, or have preexisting conditions, among other groups. Emily Gee is the health economist of Health Policy at the Center. Maura Calsyn is the managing director of Health Policy at the Center. Emily Gee. Topher Spiro , Emily Gee. Colin Seeberger Director, Media Relations. Peter Gordon Director, Government Affairs. Madeline Shepherd Director, Government Affairs. Insurance companies would no longer be required to issue rebates when they overcharge Americans.

The ACA protects people with preexisting conditions from discrimination Prior to the ACA, insurers in the individual market routinely set pricing and benefit exclusions and denied coverage to people based on their health status, a practice known as medical underwriting.

Medicaid expansion helped millions of lower-income individuals access health care and more To date, 36 states and Washington, D. Medicaid expansion was associated with 19, fewer deaths among older low-income adults from to ; 15, preventable deaths occurred in states that did not expand Medicaid.

Rural communities have benefited from the ACA Medicaid expansion is particularly important for coverage and the sustainability of the health care system in rural areas. Conclusion The ACA has helped millions of Americans gain insurance coverage, saved thousands of lives, and strengthened the health care system.

Nicole Rapfogel Research Assistant. You Might Also Like. Oct 2, Emily Gee. In addition, another study found that the number of children in the United States without health insurance increased in for the first time in more than a decade. Without access to affordable coverage, we will see more Americans forego or delay necessary medical care, putting millions of lives at risk and driving up costs to the system.

And the decline continued last year. A Gallup survey showed that by the close of , This marked the highest uninsured rate since , when the major provisions of the ACA went into effect. The greatest increase in the uninsured occurred among women, younger adults, and low income persons. The impact on people who have lost their insurance has even greater implications today than before the ACA. Health care costs are the highest they have ever been, compounded by a dramatic rise in pharmaceutical costs.

We have seen an uptick in media stories about tragedies resulting from families unable to afford treatment or prescriptions. In , more than 1 in 4 uninsured adults said they delayed or went without health care due to cost factors. Teaching hospitals have been on the front line to help uninsured Americans.