Health insurers must be mindful of costs when designing plans for the Affordable Care Act marketplace because many of its customers are still burdened with the high expense of purchasing health insurance and paying out-of-pocket costs, new research shows.
While the ACA has improved insurance affordability for many by expanding Medicaid and providing financial assistance for those with incomes below 400 percent of the federal poverty level, researchers at the Urban Institute found that some of the poorest Americans are still struggling to pay for their healthcare needs.
The study that looked at household spending on healthcare relative to income found the following results:
- Typical marketplace enrollees with incomes between 200 and 500 percent of the federal poverty level spend more than 10 percent of their income on insurance premiums and out-of-pocket costs.
- Those with high expenditures can spend more than 20 percent of their income on medical care.
- Those considered in "fair" or "poor" health, those older than 45 and those who earn less are more likely to spend a higher percentage of their income on healthcare.
The researchers urged policymakers to explore ways to protect people most vulnerable to high costs relative to their income. If not, enrollment in the marketplaces could drop and an increase in the number of uninsured could result.
Previous research has shown a decline in the number of American adults who have trouble paying their medical bills.
"Although real progress has been made ensuring people can access the care they need, there is more work to be done in terms of affordability," Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation, said in a statement. "For many, healthcare costs can still be a financial hardship that causes them to delay or forgo coverage, and ultimately, the care they need."
The importance of keeping premiums affordable was highlighted in a recent survey that showed most consumers say they can only afford $100 or less for their monthly premium in 2016.
An analysis released earlier this week from The Commonwealth Fund found that for the most part cost-sharing did not increase for those covered under ACA marketplace plans in 2015.
To learn more:
- read the study