Proposed policy changes to address unaffordability of health care

With record high insured rates, many Americans still cannot afford the care they need.

Despite historically high levels of health insurance coverage, 46% of working-age adults skipped or delayed care because of cost in the past year, and 42% struggled to pay medical bills or were paying off medical debt, according to the Commonwealth Fund Biennial Health Insurance Survey.

The survey’s results spotlight growing health care costs — particularly for hospital inpatient and outpatient services — that are squeezing Americans whose insurance doesn’t provide adequate financial protection, even as overall coverage continued to improve.

“Absent action by policymakers, this picture will likely worsen after the COVID-19 public health emergency period ends, as is expected to happen next year,” the survey reports. “This action will trigger a massive effort by states to re-determine Medicaid enrollees’ eligibility, a process that could cause nearly 16 million people to lose coverage, with many becoming uninsured.”

The report outlined three specific policy proposals to address the problem:

• To keep Americans covered, Congress could make permanent the enhanced marketplace plan subsidies that are extended for three years under the Inflation Reduction Act of 2022. The survey shows that premium costs figure heavily in consumers’ decisions to enroll and stay enrolled in marketplace plans.
• Congress also could provide a path to coverage for Medicaid-eligible people in states that have yet to expand the program. This could reduce the number of uninsured people in those states by an estimated 1.9 million. The Urban Institute estimates that blacks would make the biggest gains in those states, with uninsured rates falling by 27%.
• To help protect consumers from medical debt, Congress could ban short-term plans and other coverage that doesn’t comply with the benefit requirements of the Affordable Care Act. It also could rein in deductibles and out-of-pocket costs in marketplace plans. In addition, states could use rate regulation to limit growth in premiums and cost sharing, as Rhode Island has done.

Read more: Record high insurance coverage doesn’t mean Americans can afford health care

“This survey highlights the unique challenges of health care in the United States,” says Dr. David Blumenthal, president of the Commonwealth Fund. ”The fact that so many people in this country cannot afford needed health care — even with coverage at a record high — points to the importance of addressing health care costs. Affordable, comprehensive coverage for all Americans is essential to good health and a strong health care system.”