In the days immediately following the rollout of the Affordable Care Act, President Barack Obama stated that health care reform was necessary not only to address the millions of people without employee benefits, but also those who have coverage but are underinsured. According to new analysis, though, many people will still be in this condition when their plans are enacted and start receiving coverage, even though they're receiving financial assistance.
Chronically ill patients who have either a bronze or silver plan – two of the more affordable plan types available under the ACA – will likely reach their maximum out-of-pocket cap in each year that they are covered, despite being subsidized, according to strategic advisory services firm Avalere Health. This means that after they reach the threshold for how much they're responsible to pay for before no longer being required to, they still may not have all the coverage they need in order to finance all their medical service treatments.
For the purposes of the study, Avalere Health defined "underinsured" based on the definition of the non-partisan, public policy foundation The Commonwealth Fund. It considers it to be out-of-pocket costs that are greater than 10 percent of income for those earning more than twice the poverty level and 5 percent income for those earning less.
"Patients with high healthcare needs will benefit the most from new out-of-pocket caps, but they will still face considerable expenses before they reach the cap," said Caroline Pearson, vice president of Avalere Health. "These costs could result in inadequate or inconsistent care for high-need, low-income exchange enrollees."
Dan Mendelson, CEO of Avalere, added that the insurance consumers receive in the individual market rather than from their employers is different, as policyholders will need to assume more of the cost. As such, they should expect to pay more.
Fewer than 10 percent of Americans, in a recent poll conducted by Gallup, said that the ACA has helped them in some way since it was signed into law in 2010.
