Just a few weeks before the third Obamacare enrollment season begins, researchers are pointing out that millions of people are still uninsured, despite the law, and that there are real hurdles to convincing people to sign up.
The first two enrollment seasons made a sizable dent in the U.S. uninsured population, as about 17 million Americans have gained coverage through the Affordable Care Act’s various provisions, the Department of Health and Human Services estimated this week.
But of the millions left who are still uninsured, many haven’t tried to buy Obamacare coverage at all even though they might be eligible for subsidies to help pay for it. Those who do visit the insurance marketplaces often find it difficult to compare plans.
And just about everyone buying plans faces a steep rise in deductibles, making it harder to afford the care they need throughout the year.
Fewer than half of the Americans who visited healthcare.gov or state-run marketplaces last year actually enrolled in coverage, a Commonwealth Fund survey released Friday found. The survey also found that a majority of those who decided against enrolling said they couldn’t find a plan they could afford, even though 54 percent had incomes making them qualified for federal assistance.
“I think there is a lot of confusion both in terms of people who haven’t gone to the marketplaces at all, and once they do get there, choosing plans that are affordable for them,” said Sara Collins, Commonwealth’s vice president for healthcare coverage.
One of Obamacare’s major goals was to provide affordable coverage to those without employer-sponsored plans, and the law supplies federal subsidies to those earning up to 400 percent of the federal poverty level. The subsidies help lower the consumer’s cost, much as employer contributions help lower costs for their workers.
Besides uneducated consumers, there is the problem of skyrocketing deductibles, ailing both plans offered in the marketplaces and plans offered by employers.
A survey released earlier this week by the Kaiser Family Foundation found that while premiums are growing at a relatively modest rate, about 4 percent a year, deductibles have risen almost three times as fast since 2010 for employer-sponsored plans. And one in four covered workers are now enrolled in high-deductible plans, compared to 13 percent five years ago.
“Health costs are growing faster than the economy and they’re growing faster than workers’ paychecks,” said Joel White, president of the Council for Affordable Health Coverage. “What we’re looking at in 10 years is where the average family is going to spend half of their income on health coverage. It’s clearly not sustainable.”
The problem is of even greater magnitude among Obamacare marketplace plans, where many consumers say they bought a high-deductible plan. The Commonwealth survey found that 34 percent of Americans with employer-sponsored plans have deductibles of at least $1,000, while 43 percent of those who bought coverage in the marketplaces at deductibles at least that high.
There’s no consensus on exactly how to rein in the fast growth in deductibles, although Republicans insist that removing the healthcare law’s coverage requirements could improve the situation. But many experts feel that some of the obstacles to getting coverage could be removed simply by easing the shopping experience.
Many consumers say it’s difficult to impossible to compare the benefits and costs of different plans offered by their employers or available in the marketplaces. State exchanges could help them understand different plans by providing estimates of how a particular shopper might use a plan based on their healthcare needs, Commonwealth Fund President David Blumenthal suggested.
Such a feature wouldn’t be exact, but it would go a long way toward helping people narrow down the plan options to the ones that would best suit their particular situation, he said.
“These estimation calculations could be disease-specific,” Blumenthal said. “They could give you a sense of what your cost is based on a specific profile. I fully expect these will take shape in subsequent iterations of the exchanges.”