Some Insured Patients Still Skipping Care Because Of High Costs

Some Insured Patients Still Skipping Care Because Of High Costs

11:18am Jun 13, 2015
Renee Mitchell says even though she has health insurance she'll have trouble paying for the eye surgery she needs to save her vision.
Renee Mitchell says even though she has health insurance she'll have trouble paying for the eye surgery she needs to save her vision.
Jim Burress/WABE
Renee Mitchell says even though she has health insurance she'll have trouble paying for the eye surgery she needs to save her vision.

Renee Mitchell says even though she has health insurance she'll have trouble paying for the eye surgery she needs to save her vision.

Jim Burress/WABE

A key goal of the Affordable Care Act is to help people get health insurance who may have not been able to pay for it before. But the most popular plans – those with low monthly premiums – also have high deductibles and copays. And that can leave medical care still out of reach for some.

Renee Mitchell of Stone Mountain, Georgia is one of those people. She previously put off a medical procedure because of the expense. But as the threat of losing part of her vision became a real possibility, she sought an eye specialist at Emory University, who told her she'd need surgery to correct a cataract procedure gone wrong.

That's not the scariest part, she says. Cost is: "further copays [and] more out-of-pocket expenses."

Mitchell is generally pleased with her insurance — a silver-level Obamacare plan. It's the most popular level plan with consumers because of the benefits it provides for the money. But she still struggles to keep up with her part of the bills.

"If not for having availability on my credit card, we'd probably be in the poorhouse," Mitchell says.

She still owes more than $20,000 for several years of medical expenses, with more debt accruing in interest each month. If she undergoes that eye surgery, she says, she'll owe another $4,000 – the deductible for the operation.

"It's a very big burden," Mitchell says.

A recent study released by the nonprofit Families USA shows that a lot of folks with coverage like Mitchell's feel a similar burden, and a poll from the Kaiser Family Foundation finds the same thing. The majority of people who buy insurance on state or federal exchanges pick silver-level plans, which often carry a lower monthly premium, but have a high annual deductible – $1,500 or more.

"Consumers are still struggling with unaffordable, out-of-pocket costs," says Lydia Mitts, a senior policy analyst with Families USA. "One in four adults who were fully insured for the whole year still reported they went without some needed medical care because they couldn't afford it," Mitts says.

Many people in that situation skip follow-up care and don't fill prescriptions. Mitts says that only adds to long-term complications and costs.

But it doesn't have to be that way, she says. Plans in some states, including Pennsylvania, Texas, Florida and Arizona, have recently done away with deductibles on some silver-level insurance plans. And for certain basic services, including doctors' visits and generic prescriptions, other states are requiring only a small copay.

Still, while copays, deductibles and co-insurance weigh heavy on Renee Mitchell's mind, they're not her only insurance concern. Her monthly premium is also getting more expensive. This year, she says, it jumped by about $100 a month.

Mitchell wants to be clear, though: She's not looking for a handout.

"People seem to think that we just want something for nothing," she says. "I worked a lot of years. I took an early retirement to take care of my family. It's not my fault, so to speak, that I'm here."

This story is part of NPR's reporting partnership with WABE and Kaiser Health News.

Copyright 2015 WABE-FM. To see more, visit http://www.wabe.org/.

Transcript

ROBERT SIEGEL, HOST:

The health care law is called the Affordable Care Act, but many people are finding it's not affordable enough. The high deductibles and co-pays that come with the most popular plans can still leave care out of reach. Jim Burress of member station WABE in Atlanta explains.

JIM BURRESS, BYLINE: Renee Mitchell just finished up an appointment with her eye specialist at Emory University Hospital. The 63-year-old from Stone Mountain, Ga., learned she needs surgery to correct a cataract procedure gone wrong. But that's not even the scariest part. Cost is, she says.

RENEE MITCHELL: Further co-pays, more out-of-pocket expenses.

BURRESS: When Mitchell was uninsured, she put off procedures like this. Now she has a silver level Obamacare policy. It's the most popular plan with consumers because of the benefits it provides for the money. But she still struggles to pay.

MITCHELL: Not for having availability on my credit card, we'd probably be in the poor house.

BURRESS: Mitchell owes upwards of $20,000 for several years of medical expenses, and if she gets that surgery, she'll face a $4,000 deductible.

MITCHELL: It's a very big burden.

LYDIA MITTS: Consumers are still struggling with unaffordable out-of-pocket costs.

BURRESS: Lydia Mitts is with Families USA, a nonprofit advocacy group. It finds many of those with a silver level Obamacare policy find it hard to pay their medical bills.

MITTS: One in 4 adults who were fully insured for the whole year still reported that they went without some needed medical care because they couldn't afford it.

BURRESS: Many skipped follow-up care and don't fill prescriptions. But Mitts says it doesn't have to be that way. For example, Pennsylvania, Texas, Florida and Arizona have done away with deductibles on some plans. Some other states require only a small co-pay for basic services.

MITTS: They've waived the deductible for things like primary care visits, diagnostic tests and lab work, specialty care office visits, even some prescription drugs.

BURRESS: And it's more than just co-pays and deductibles that worry Renee Mitchell. This year, her monthly premium jumped about a hundred dollars. As she faces that eye surgery, she wants to make it clear she's not looking for a handout.

MITCHELL: I feel like people seem to think that we just want something for nothing. I worked a lot of years. I took an early retirement to take care of my family. It's not my fault, so to speak, that I'm here.

BURRESS: Mitchell stresses she's grateful to have health insurance. She just wants it to be affordable enough that she can use it. For NPR News, I'm Jim Burress in Atlanta.

SIEGEL: And that story is part of a reporting partnership of NPR, WABE and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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