Is The Affordable Care Act Helping Patients Who Need It Most?
For millions of Americans, health insurance used to be unaffordable. For the poorest of the uninsured, a health emergency was often the tipping point for going into medical debt or bankruptcy. The Affordable Care Act was designed to help these people get quality and affordable healthcare coverage by creating an individual health exchange with four levels of plans- platinum, gold, silver and bronze.
The bronze plans are the riskiest because they have high out-of-pocket deductibles to offset low monthly premiums. These plans are the most appealing to patients who are unable or unwilling to pay the higher monthly costs. But are bronze plans really achieving their goal of providing quality, affordable healthcare to people who need it most?
A study published in the American Journal of Medicine reported that 62.1% of all bankruptcies in 2007 were due to medical costs. Many of the types of individuals examined in this study are now the ones signing up for bronze plans, and are often the ones who are most vulnerable to winding up in debt or bankruptcy as a result of high medical bills. While this is one of the key populations that the Affordable Care Act was supposed to help the most, there are indications that that for these patients, the government’s answer might be just as risky as being uninsured.
According to health economist Geoff Joyce from the Schaeffer Center for Health Policy and Economics, when bronze plan patients fall prey to illness or injury, they will bear 40% of their healthcare costs, which can amount to thousands of dollars. But they sign up because these plans have the lowest monthly premiums, prices generally ranging from $30-300 depending upon the individual’s income and location. These plans tend to be the most affordable type of mandated health insurance and are often referred to as “catastrophic coverage”.
Anthony Wright, the executive director of a patient advocacy organization called Health Access California, says that these bronze-level patients primarily fall into two categories: younger patients who make a calculated risk-reward decision, and older, less-healthy patients who simply cannot afford the higher premiums of alterative-level plans.
Carmen Amaya is one of these patients. She gets her healthcare from Covered California, the state’s private health insurance exchange. Amaya once had a bronze plan but switched when her out-of-pocket healthcare costs grew too high. She is now on a silver plan, which has helped her keep her costs down and provided her with more comprehensive coverage.
“When I used to go to the doctor I paid more on copayments,” Amaya says. “And I paid more for my medication. So with silver I pay less with my copayment and my medication and I have more visits.” While Amaya acknowledges that her up-front healthcare costs may be higher, she believes she is saving money and getting more care in the long run with a silver plan.
Amaya is grateful for her coverage. “Before, I used to pay $300 a month for my health insurance. $300 compared to $39. That's a lot right? So I'm grateful for Covered California, let's make that clear,” she says.
Amaya has just one complaint. “It's just too complicated,” she says. “I think they need to make it easier for the community to understand.”
Efforts are already underway in the California legislature to make the health insurance marketplace more efficient and easier for patients to navigate in anticipation of November enrollment. But whether or not people do understand the complexities of the healthcare plans available to them will be reveled during next month’s open enrollment period for the Affordable Care Act.
