- Passage of the Affordable Care Act in 2010 and its enactment six years ago helped cut the nation's uninsured by nearly half, from 49.9 million in 2010 to 25.6 million in 2017. Nevertheless, a huge unmet need remains for many to access medical services, according to a study published Monday in JAMA Internal Medicine.
- Between 1998 and 2017, the share of the U.S. population unable to see a doctor due to the associated costs of doing so rose from 11.4% to 15.7%, although the differences were even starker when divided among those with insurance coverage and those without. There were also increases in inability to see a physician among those with chronic conditions, and the proportion of women receiving mammograms dropped.
- The study, authored by physicians and researchers from Harvard Medical School, the Cambridge Health Alliance and Hunter College, suggests that narrowing provider networks as well as increasing co-payments and out-of-pocket costs may be driving the trend.
More people have obtained insurance in recent years, but more are also being saddled with costs that not only burden their pocketbooks but also threaten their health.
The study's authors analyzed 20 years of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, starting from January 1998 to the end of 2017. The data focused specifically on any adults ages 18 to 64, about 360,000 in all.
During that time period, the proportion of the economy devoted to expenditures on healthcare rose from 13.3% to 17.9%. Meanwhile, the proportion of uninsured in the survey shrunk from 16.9% in 1998 to 14.8% in 2017. Among African-Americans, it dropped from 22.1% to 16.6%.
Although the proportion of the population who could not afford to see a doctor rose 4.3 percentage points, the differences between those who have coverage and those who do not was striking.
Among those who lacked insurance, those who could not afford to see a doctor rose from 32.9% to 39.6% during the study's time period. That's an overall increase of 20.3%. But among those who had insurance, those who could not afford a doctor rose from 7.1% to 11.5% — an increase of nearly 62%.
The study was accompanied by a commentary penned by John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan. He noted that although the ACA significantly increased the number of insured, those middle-class and upper middle-class Americans with incomes about 400% of the federal poverty level (about $103,000 for a family of four) are feeling a squeeze. That group "saw no reduction in out-of-pocket spending and a significant 23% increase in health insurance premiums from 2012 to 2015," he wrote.
The study raised concerns about this rising gap of those unable to see a doctor, particularly those with chronic conditions. "Financial barriers to care have been associated with increased hospitalizations and worse health outcomes in patients with cardiovascular disease and hypertension and increased morbidity among patients with diabetes," the authors observed.
The study also noted the financial barriers to seeing doctors was far more formidable in the U.S. than in other countries. The Organization for Economic Co-operation and Development concluded only 9.1% of people worldwide skipped seeing doctors due to cost — in the U.S., the rate was 72.5% higher. In neighboring Canada, only 1% of citizens couldn't afford to see a doctor.