Insurance subsidies leading to issues with access and affordability
A new study from researchers at Case Western Reserve University School of Medicine in the US has found that due to high out-of-pocket expenses, Ohio residents who purchase subsidised health-exchange insurance often can't afford the care they need when they need it.
The study's senior author Dr Siran Koroukian, Associate Professor in the Department of Population and Quantitative Health Sciences, explained more about the situation: “High out-of-pocket costs associated with exchange health plans often mean that those who don't qualify for Medicaid face significant barriers to accessing affordable care. As a result, they delay or omit needed care; and the likely scenario is that they become sicker before they eventually qualify for Medicaid. This creates a paradox: they formally have insurance, but because they can't afford the high deductibles and co-pays, they may be worse off medically than those without insurance or who receive Medicaid, which has nominal co-expenses.”
The research team examined almost 43,000 Ohio adults and found that low- to middle- income individuals who received subsidies to purchase insurance through health insurance exchanges established under the Affordable Care Act were significantly more likely to experience problems with access and affordability, such as skipping doctor's visits and not filling prescriptions, than those insured through Medicaid expansion generated by passage of the ACA.
“We know that ACA has insured more people, which was its intent, but there is work to be done in making that insurance more effective in getting care for low- and middle-income people,” said the study's lead author, Uriel Kim, an MD/PhD student in the School of Medicine. “Typically we think of Medicaid recipients as more vulnerable than those with private insurance. But in reality, Medicaid expansion has gone well because it is meeting its goal of increasing access to affordable care for its users. At the same time, relatively high out-of-pocket expenses mean that some recipients who use exchanges are choosing to go without care, which in the long run makes them sicker – even having to turn to Medicaid to get the care they need.”
The findings of the study suggest that increasing Affordable Care Act cost-sharing subsidies or raising the income threshold for Medicaid eligibility would expand accessibility. “Either way, this would ultimately save taxpayer’s money by keeping people healthier and not forcing them into financial toxicity,” said Koroukian. “This is especially true in expensive cases such as cancer. Higher out-of-pocket expenses can result in delays in getting cancer tests, resulting in later-stage diagnoses, sicker patients, greater expenditures, and often poorer patient outcomes.”