Cost Woes Continue Keeping Patients Away from the Doctor

One year after the roll out of the Affordable Care Act, widely known as Obamacare, the debate still rages. Is it working to make healthcare coverage more affordable for millions of Americans? Is it inadvertently preventing employers from hiring full-time employees due to new regulations for businesses? Overall, is it helping Americans find affordable health insurance?

According to a recent CBS News/New York Times poll, 51 percent of Americans disapprove of the Affordable Care Act (ACA) while 41 percent approve of the new law. Partisan lines are clearly drawn in the sand when it comes to the ACA – 67 percent of Democrats approve of the law, while 83 percent of Republicans disapprove of the president’s signature achievement.

Why Can’t Many Americans Afford to See a Doctor?

Based on news reports, it would seem that healthcare premiums are either skyrocketing or plummeting, depending on the reporting source of news. For most people, healthcare premiums will rise. However, directly citing the Affordable Care Act as the sole blame for increases may be overkill as it could be merely a function of inflation and annual rising prices. The cost of medical care and equipment seems to rise year after year, and health insurance premiums are at least somewhat correlated with these costs.

However, a recent analysis from PricewaterhouseCoopers (PWC) throttles the loudest voices on both sides of the debate. Healthcare premiums did increase like the Republicans warned, –however, premiums didn’t skyrocket. Many Democrats told us that premiums would go down and, at least on average, that didn’t happen, either.

According to the analysis by PWC, the average rate increase was 7 percent. They also predict an 8.2 percent increase next year in Washington D.C. and in the 29 states that have released data. Healthcare costs do seem to be rising, but it may be difficult to actually determine how much, if any, of that increase is from the implementation of the ACA.

What’s more, many people are opting for health insurance plans that offer lower premiums. Unfortunately, higher co-pays and deductibles usually accompany these lower premiums. It’s typically a tradeoff – pay less now, pay more later. Some young and healthy individuals may opt for the lower premiums, because they don’t anticipate going to the doctor much while some who may have pre-existing conditions will not want higher out of pocket costs and will therefore opt for higher premiums.

A poll conducted by the Associated Press-NORC Center for Public Affairs Research found that 29 percent of Americans enrolled in a high deductible plan avoided going to the doctor because of the associated out-of-pocket costs, even when they should have due to an illness or injury.

More Healthcare Plans, Lower Premiums?

Health and Human Services Secretary Sylvia Burwell recently stated that the number of insurance companies offering plans in 2015 on the Affordable Care Act’s exchange marketplaces will increase to 248. This represents a 25 percent increase and could bode well for the cost of healthcare premiums.

More competition usually means lower prices; however, only time will tell whether the availability of these companies will be widespread or simply serve to increase competition in specific areas of the country. Burwell also said that Americans should learn what to look for when shopping for a plan in order to get the most benefit. Many consumers are signing up blind to what they actually need.

Furthermore, the ACA requires preventative care to be covered at no additional charge, and it seems some are not getting that. In fact, the same study showed that 24 percent of people did not carry out their routine preventative care because of the cost.

Do More People Now Have Healthcare Under the Affordable Care Act?

In May, Gallup released a survey showing that those covered by health insurance increased by more than 8.9 million in the past year. A New England Journal of Medicine study was cited by The Health and Human Services Department that estimated some 10 million adults have gone from being uninsured to having healthcare coverage.

On August 15, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, told the House Oversight and Government Reform Committee that the number of Americans who have enrolled in the new ACA marketplaces and paid their healthcare premiums stands at 7.3 million. The numbers vary, but they do seem to indicate that Americans have responded to the ACA by enrolling in healthcare plans.

Young adults, those between 18 and 34, need to sign up in order for the law to support itself. Obama’s stated goal was for young adults to account for 40 percent of the exchange enrollments. Has this number been reached? It seems that the 40 percent figure has not been achieved, but that some young people are generally searching for plans and signing up. According to the U.S. Census Bureau, the rate of uninsured young adults (ages 18-34) has dropped from 28.1 percent in 2009 to 25.2 percent in 2013.

Between 2012 and 2013, the number of uninsured young adults dropped by 367,000. Because Open Enrollment started on October 1, 2013 and many young adults signed up after the start of 2014, it can be reasonably and safely assumed that the percentage of uninsured 18-34 year olds has decreased further.

More Numbers on the Affordable Care Act

In June, Forbes.com had a headline that read: “3,137-County Analysis: Obamacare Increased 2014 Individual-Market Premiums by an Average of 49%.” Their methodology involved using an average of the five least expensive plans in a specific county prior to the rollout of the ACA and then taking an average of the five least expensive plans on the Affordable Care Act exchanges in each county.

This methodology took into account pre-existing conditions and health problems in the prices prior to the implementation of the ACA, and it did not use the subsidized prices in the costs under the ACA.

This figure – 49 percent – represents a significant increase for healthcare shoppers if it actually gives us a true image of what Americans are finding when they shop for healthcare coverage. Because their study seems to be substantial, it is certainly worth a look.

The nonpartisan Congressional Budget Office (CBO) has not officially assessed the budgetary impact of the Affordable Health Care Act since the summer of 2012. At that time, they predicted that the law would reduce deficits by $109 billion in the next decade, from 2013 to 2022. However, things have changed since they released that prediction. The initial rollout saw computer glitches and security issues along with numerous attempts by the Republicans to repeal the law.

President Obama has delayed enforcing portions of the law, such as the employer and individual mandates, which also increases the potential costs. Because of these issues over the past year, the 2012 numbers are in need of updating.

Because the Affordable Care Act is a complicated law, the numbers describing its effects can also get quite complex. The more complex the numbers, the easier it is to twist them to a specific point of view.

One thing seems to be constant, those who tend to be more liberal and vote Democrat more often seem to find healthcare premiums to be lower than expected and less than their previous plans; those who tend to be more conservative and vote Republican more often, tend to find healthcare premiums much higher than before the ACA. That’s a strange phenomenon that could only be possible in our highly divided blue state/red state nation.

The Future

Only time will tell if the Affordable Care Act is a success or a failure. Real numbers are needed to continually assess its effect on our nation’s economy. There are still millions of Americans without healthcare and millions who can’t afford coverage. With the price of healthcare still rising, unemployment still an issue, and persistently stagnant wages, this is unlikely to be changed significantly by the ACA.

However, at the one-year mark, it seems as if more people are signing up on the government exchanges. People are searching for healthcare, especially young people and those with pre-existing conditions. Nonetheless, a true picture of the premium price is a bit more elusive.

One year is not enough time to assess a law with this much potential impact on our society. A completely nonpartisan study may have to be performed on the price of healthcare plans, across states, gender, age, and health conditions before a true accounting of the law can be rendered.