Affordable Care Act Wins and Losses

Since the passage of the Affordable Care Act in 2010, fewer people are uninsured but the number of underinsured has spiked, especially among people covered by employer-sponsored health plans, according to a recent study.

An estimated 44 million people who were insured throughout 2018 did not have adequate coverage because of high out-of-pocket costs and deductibles, up from 29 million in 2010, according to a report by The Commonwealth Fund. The biggest increase in underinsured adults is occurring among those in employer health plans.

“What we are seeing is a steady upward trend of higher out-of-pocket costs and deductibles,” said Sara Collins, a co-author of the report. “We are seeing an increase in the size of deductibles relative to income. It’s a trend in employer benefits as employers look for ways to share health care costs. People in the individual market are most likely to be uninsured, but the trend in employer-based plans is distinctive.”

The report defines the underinsured as those with out-of-pocket costs that are 10 percent or more than their household income or deductibles that exceed 5 percent of their household income.

Fewer people are uninsured since the Affordable Care Act was passed in 2010, but of the 194 million U.S. adults ages 19 to 64 in 2018, about 45 percent lacked adequate coverage, according to the report.

“We expected to see a decline in the uninsured but we hadn’t predicted the ongoing steady growth in the number of underinsured,” Collins said. “Much of that growth is among those in employer plans, which are outside of the reach of the ACA.”

More than half of Americans under age 65 — about 158 million — get their health insurance through an employer, according to The Commonwealth Fund. The ACA requires large employers to provide affordable coverage, but the requirement amounts to just 60 percent of overall costs.

“Employers are at an inflection point where deductibles have risen so far that it’s putting people’s access to health care in jeopardy,” Collins said. “There needs to be some rethinking of employee benefit design. It points to the fact that the real issue that needs to be addressed is the rise in health care costs and that’s going to take a systematic national effort to address.”

Also read: The 4 Myths of Health Care Cost Reduction