More Americans Gain Health Coverage, But Many Can't Afford to Use It: Doctors Group

Census Bureau says number of uninsured has dropped to 33 million in wake of Affordable Care Act, but is silent on problems of rising deductibles, copays, coinsurance and narrow networks that deter people from seeking care

"The Census Bureau's official estimate that 33 million Americans lacked health insurance in 2014 reflects a significant and welcome drop from the 42 million it reported as uninsured in 2013," said Dr. Robert Zarr, president of Physicians for a National Health Program, today. "But the number of people who remain without coverage is still intolerably high. And the Census Bureau report leaves entirely unmentioned the millions of people who have health insurance but who can't afford to use it because of high deductibles and copays."

"Having health insurance is better than not having coverage, as several research studies have shown," Zarr, a Washington, D.C.-based pediatrician, continued. "For example, the 33 million people the Census Bureau says were uninsured in 2014 means that approximately 33,000 people died needlessly last year because they couldn't get access to timely and appropriate care." He cited a landmark study in the American Journal of Public Health showing that for every 1 million persons who are uninsured in a given year, there are about 1,000 deaths linked chiefly to that factor.

"That's an unnecessary death every 16 minutes," Zarr said. "That's completely unacceptable. Moreover, the Congressional Budget Office predicts at least 27 million people will be uninsured every year for the next 10 years - so that's tens of thousands of preventable deaths, year in and year out.

"And keep in mind that even if all the states had accepted the Medicaid expansion, about 24 million people would still be uninsured under the Affordable Care Act," he said. "We simply can't go on like this."

Zarr pointed out that the problem of underinsurance - i.e. of people having skimpy policies with high deductibles, copays, and other forms of cost sharing that deter them from seeking care and that leave them vulnerable to financial distress and medical bankruptcy in the event of serious illness - is not something the Census Bureau addresses in its annual reports. But it should take this question up, he said, especially in view of how rapidly the problem is worsening.

"A recent study by the Commonwealth Fund shows that about 31 million people who have health insurance - nearly a quarter of all insured non-elderly adults - are underinsured, nearly double the rate in 2003," Zarr said. "Of these, 44 percent went without a doctor's visit, medical test, or prescription due to cost, while 51 percent had problems paying off medical bills or were paying off medical debt over time.

"The average deductible - i.e. before insurance kicks in - for families with popular silver plans in 2015 is estimated to be $6,010, and out-of-pocket costs for copayments and deductibles, after premium payments, for a family of four with an income of about $60,000 per year can be as high as $13,200," he said. "And of course this applies to 'in network' services only. Out-of-network costs can go much, much higher. Such financial barriers are untenable, economically and morally."

"In short, under the new health law we're witnessing a dramatic acceleration of the trend of shifting more and more medical costs onto the shoulders of patients and their families, even as medical costs and premiums rise and as private health insurance companies reap record profits.

"How is it possible that in 2015 one of the richest countries in the world still does not guarantee every resident the right to health care?" Zarr continued. "This question would not be necessary if we had a health care system worthy of the name - single-payer national health insurance, or an improved and expanded Medicare for All."

"A single-payer system would achieve truly universal care, affordability, and effective cost control. It would put the interests of our patients - and our nation's health - first."

Zarr continued: "Our patients, our people and our national economy cannot wait any longer for an effective remedy to our health care woes. The stakes are too high. We need to move beyond the administratively wasteful, complex and inadequate ACA to a more fundamental, comprehensive single-payer national health program for all."