- The Washington Times - Thursday, May 14, 2015

One in four people who bought health insurance on their own couldn’t afford medical care last year, according to a study released Thursday that shows out-of-pockets costs are still getting between Americans and their doctors despite Obamacare’s progress in cutting the ranks of the uninsured.

Families USA studied people who purchased insurance in the non-group market — they weren’t covered through their jobs or a public program — in 2014, the first full year for which Obamacare’s marketplace was fully operational, and found 25.2 percent struggled to get care or pay for needed drugs.

Some of those studied entered Obamacare’s health exchanges, while others sought out coverage in the off-exchange market.

Lower and middle-income people were hit especially hard by high deductibles — the amount that must be paid before insurers will pay a claim — and other expenses that come straight from their wallets.

Among those who passed up care, 15 percent went without tests or followups, 14 percent passed on prescription drugs and 12 percent gave up medical care.

Government officials say more than 16 million Americans have gained coverage from the Affordable Care Act’s coverage provisions, although some have complained that consumers still face prohibitive costs.

“Simply having health insurance is no guarantee that consumers can afford to pay for health care,” the study says. “Health insurance involves different types of costs that consumers must pay out of pocket — ranging from a health plan’s deductible to copayments at a doctor’s office. These expenses add up, and research has shown that even nominal cost-sharing can deter people from getting needed care.”

Families USA, which contracted with the Urban Institute to crunch the numbers, split its research into two subsections of people who make 100-400 percent of the federal poverty level, the income range that allows people to qualify for financial help from Obamacare.

Among those with lower to middle-incomes — $16,200 to $29,199 as an individual, or from $27,400 to $49,499 for a family of three — more than a third reported going without care because it was too expensive.

About two of every five people with middle-to-higher incomes — $29,200 to $46,699 for an individual, or $49,500 to $79,199 for family of three — went without care.

Nearly 30 percent of people with deductibles of $1,500 or more skimped on care, a portion that dropped to about 20 percent among those with deductibles under $1,500.

“Proponents of high deductibles argue that because high-deductible plans require consumers to pay more of their medical costs up front, these plans give consumers an incentive to use health care more wisely,” the study said. “However, our findings and previous research tell a different and more troubling story: High deductibles are associated with consumers having difficulty getting the care they need.”

Researchers excluded dental care in their study, because most health plans do not cover it among adults. For instance, Obamacare only considers it an essential health benefit for children.

As a result, researchers said numerous reports show that dental care is the most common type of care skipped by adults due to affordability issues.

Nearly a quarter of those who held health coverage for a full year said they did not go to the dentist because it cost too much.

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