HEALTHCARE IN THE UNITED STATES
ACCESS ISSUES IN HEALTH CARE
from 1997, 2005, and 2010. In 2017, 7.4% of respondents stated they delayed or did not receive needed medical care due to costs. This percentage was the lowest percentage in the 10- year recorded period. Of those responding to the question about not receiving needed prescription drugs due to cost, 5.1% stated they had not received medications as needed. Only the year 1997 was lowest, with 4.8% not receiving medications due to cost. Of those responding that they didn’t receive needed dental care due to cost, 9.5% agreed that they had not received dental care. Again, this was the second lowest percentage, with 8.6% responding in 1997 that this was a problem. Although these are relatively small percentages, the goal is that no one delays or doesn’t receive medical care when needed.
8.5.2 Health Insurance Costs and the Relationship to Access
Costs associated with health insurance, such as high deductibles, copays, and out-of-pocket expenses, can be a barrier to healthcare. Many individuals have private insurance with high deductibles, some employer-based and some individually purchased. The U.S. Centers for Medicare and Medicaid Services (U.S. CMS, n.d.) define a high deductible health plan as “a plan with a higher deductible than a traditional insurance plan” (para. 1). With a high deductible plan, the monthly premiums are lower, but the beneficiary pays a large amount of the healthcare costs before the insurance company pays for any of the healthcare costs. “For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1400 for an individual or $2800 for a family” and limits “total yearly out-of- pocket expenses (deductibles, copayments, and coinsurance) to $6,900 for an individual or $13,800 for a family,” if using in-network services only (receiving services outside of the insurance’s approved providers would result in higher costs to the individual and/or family) (U.S. CMS, n.d., para 3).
The 2018 National Health Interview Survey (NHIS) indicated that the numbers of individuals with high deductible health plans increased from 43.7% in 2017 to 45.8% in 2018 for persons under the age of 65 (Cohen et al., 2019). Moreover, according to Kirzinger et al. (2019), surmising the results of several Kaiser Family Foundation (KFF) healthcare tracking polls suggested that about one-fourth of insured workers were required to pay an increased deductible averaging 212% over the last decade, resulting in an approximate deductible of $2000 or more for a single person.
Having a high deductible where out of pocket costs must be paid prior to the insurance covering prescription drugs or medical costs may deter individuals from seeking healthcare. Kirzinger et al. (2019) described one KFF 2018 poll where results indicated that 34% of insured adults found it difficult to pay health insurance deductibles, 28% found it difficult to pay monthly premiums for health insurance, and 24% found it difficult to pay the co-pays for health-related costs, such as visits to a physician’s office and prescription medications. Another KFF poll, performed in 2017, (Kirzinger et al., 2019), presented a scenario to those with employee-sponsored insurance (ESI) asking them if they had to pay $500 of an
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