Critics say high deductibles make insurance ‘unaffordable’
COLUMBUS, Ohio — When President Obama’s landmark health care law ushered in a slew of new insurance options in 2013, the Andersons could not wait to sign up.
Roger Anderson, 54, a formerly uninsured construction worker, has a bad back and a bad heart. He and his wife are still paying for his earlier heart surgery and feared another crisis could ruin them.
“This law was going to give people a chance,” said Cassaundra Anderson, 44, a freelance proof reader.
But in April, when Roger Anderson fell while hiking and hurt his shoulder, he discovered, to his dismay, that simply being insured was not enough. The Andersons’ mid-tier plan, which costs them $875 a month, requires them to meet a $7,000 deductible before insurance payments kick in.
“We can’t afford the Affordable Care Act, quite honestly,” said Cassaundra Anderson, whose family canvassed for Obama in their neighborhood, a Republican stronghold outside Cincinnati. “The intention is great, but there is so much wrong. . . . I’m mad.”
The Andersons’ experience echoes that of hundreds of thousands of newly insured Americans facing sticker shock over out-of-pocket costs. Although the law survived two Supreme Court challenges, it could still be on the line in the 2016 presidential election, posing a significant political barrier to Democrats in this critical battleground state, which includes both conservative rural sections of Appalachia and diverse cities.
The problem experienced by the Andersons is particularly acute in Ohio, which has the fourth-largest number of people enrolled in high-deductible insurance plans in the country, after Texas, Illinois, and Pennsylvania, according to America’s Health Insurance Plans, the industry’s trade association based in Washington.
Now that the law’s major provisions are in place, the outcry over cost has prompted Hillary Clinton, the Democratic front-runner, to call for changes to Obama’s signature domestic achievement.
“This will be an issue at least one more time in the 2016 election. It could absolutely still hurt Democrats,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. “Polls about the Affordable Care Act have a considerable amount of middle-income people who say either the program has done nothing for them or actually hurt them.”
Governor John Kasich, like other Republicans running for the party’s presidential nomination, blames rising insurance costs on Obama’s 2010 health reform law and has called for its repeal. Clinton defends the Affordable Care Act on the campaign trail but is pledging to lower out-of-pocket costs including deductibles and making affordable health care a “basic human right.” Senator Bernie Sanders, a self-described socialist challenging Clinton for the Democratic nomination, says Obama’s health law does not go far enough and advocates for a “Medicare-for-all” single-payer system instead.
The percentage of Ohioans who view the law unfavorably is higher than in the nation as a whole, especially among independents and Democrats, according to new data from the annual Ohio Health Issues Poll. Nearly half of Ohioans do not like the law, compared with the 42 percent national figure reported by the Kaiser Family Foundation in October.
Nearly 30 percent of people insured through the federal marketplace who had deductibles higher than $1,500 went without needed medical care in 2014 because they could not afford it, according to Families USA, a health care consumer group based in Washington. That includes diagnostic tests, treatments, and follow-up care as well as prescription drugs.
Deductibles have grown six times faster than wages since 2010, according to a recent Kaiser Family Foundation study. The growing national problem is also reflected in Massachusetts, where a 2015 annual report by the state’s Center for Health Information and Analysis shows that more than half of those enrolled in individual plans faced high deductibles.
“Unfortunately, what we are headed toward now is universal crappy health insurance,” said Dr. Budd Shenkin, a California pediatrician who wrote the American Academy of Pediatrics policy on high-deductible plans, which he calls nefarious.
“It’s just not a good deal for people,” he said. The academy last year advised the federal government to restrict such plans to adults because they discourage families from seeking necessary primary care for their children.
The Obama administration, in response to the criticism, acknowledges that high deductibles are an “important issue” but says the problem is part of longstanding insurance trends.
A spokesman for the Department of Health and Human Services points out that the law, for the first time, caps the out-of-pocket costs families pay to $13,700. It recently introduced an online “cost calculator” that gives those shopping for insurance a fuller picture of their total out-of-pocket costs.
The Affordable Care Act, while providing coverage to millions of previously uninsured Americans, does nothing to turn the tide away from high-deductible plans. The government provides subsidies that lower premiums and out-of-pocket costs for people with incomes below 250 percent of the federal poverty line, individuals making less than $30,000 a year. More than half of those buying insurance through the marketplace receive subsidies to offset copays and deductibles, according to the administration.
But those with more moderate incomes receive no help. Mandated by the law to buy coverage, they most often opt for high-deductible plans as a way to make their monthly premium payments more manageable. And they end up making medical decisions much like they did when they were uninsured, advocates say — by putting off care.
In fact, the growing use and size of deductibles as a way to lower premiums “threatens to undermine the gains Americans have made in coverage since 2014,” according to a September report by The Commonwealth Fund on the affordability of marketplace plans.
Cost concerns have lead tens of thousands of the newly insured to drop their Affordable Care Act plans and opt for free or discounted care at community health clinics. Consumer advocates worry that the numbers will increase as the trend toward high deductibles worsens.
Cassaundra Anderson has been bombarded by a slew of e-mails reminding her to reenroll when the 2016 sign-up period for marketplace plans begins in November. She is not certain the family will re-up. Their premium next year would jump to more than $1,000 a month.
“We’re in the process of looking at going without insurance,” she said, calculating that the family will be better off financially just paying the $2,000 tax penalty for not abiding by the law’s mandate. “What am I even paying these insurance people for? Why should we reenroll?”
She figures that the amount the couple pays toward their insurance premium could instead go toward paying off her husband’s latest round of medical bills, now tallying $6,700. The mounting debt has Roger Anderson choosing to forgo the twice-weekly physical therapy prescribed by his doctor — and losing muscle mass as a consequence — because he can’t afford the $200-a-month copay. He’s also skipping a follow-up MRI of his back.
Cassaundra Anderson said she still plans on voting for whoever the Democratic nominee for president will be. “Republicans who have fought this law tooth and nail are not going to try to make it better,” she said.
But independent swing voters may not be as forgiving. “If they are having the experience we’re having, they are going to say, ‘This is a lot of doo-doo,’ ” she said.
On a recent afternoon, Laura Torres, a 62-year-old home health aide who is in nursing school, visited a community health clinic tucked into a strip mall 20 minutes from downtown Columbus. This is where she sought care when she was uninsured, paying an affordable sliding scale rate based on her $22,000 yearly income.
Now she visits Whitehall Family Health Center seeking financial — not medical — help. An insurance counselor there helped Torres apply for a government subsidy, lowering her $6,000 deductible to $800. But she says she was better off before having to buy insurance.
“I cannot get anything with this insurance. Nothing,” said Torres, who avoids seeking treatment for her thyroid condition and high blood pressure because of cost. “I just pay my monthly payments, try to take care of myself, go to work, and hope something serious doesn’t happen to me.”
Amete Kahsay, 53, works as a temporary warehouse packer in Columbus. The Affordable Care Act marketplace is her only option for health insurance. She and her husband, an airport shuttle driver, pay $275 a month for a “bronze” plan with a $13,200 deductible.
Shortly after they signed up for insurance last year, her husband rushed her to the emergency room when she experienced dizziness. The visit, which included a CT scan of her brain, cost $1,700. She paid the charge from her savings, then returned to her native Ethiopia, where care is cheaper, to consult a neurologist and seek follow-up care.
“I support Obamacare. Without it, I wouldn’t have any type of insurance. But I’m not sure it’s worth the money,” said Kahsay, a US citizen who is registered as an independent voter. “Now, unless I get very, very sick, like only if it’s life-threatening, I won’t go to the doctor. I just lay down and take a rest.”