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ACA Update: When Medical Insurance Doesn’t Result in Medical Care

Amid continuing partisan debate on Capitol Hill about the Affordable Care Act, the facts are clear: the law has significantly reduced the number of uninsured Americans. Last week the federal government issued a report indicating more than 16 million people who did not have health insurance before have gained coverage thanks to the ACA. According to the Department of Health and Human Services, these gains have delivered the largest drop in the uninsured rate in four decades, bringing that rate down to 13.2 percent.

Linda Barlow

Linda Barlow

“These numbers prove the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result,” said HHS secretary Sylvia Burwell.

While few would dispute that having medical coverage is better than not having medical coverage, coverage is not always a panacea for all ills. First, consumers need to take advantage of the coverage they now have. The federal government recognizes the gap between having medical insurance and getting medical care and has established a website to help consumers use their new marketplace coverage.

For about 19 percent of privately insured adults, higher cost-sharing responsibilities are to blame for the lack of medical care received. Fortunately, the number of Americans reporting they did not receive needed health care because of its cost dropped for the first time last year since 2003, falling from 80 million in 2012 to 64 million in 2014. Still, twenty-one percent of adults with health insurance spent 5 percent or more of their income on out-of-pocket health care costs during 2014, and 13 percent spent 10 percent or more, according to a report from the Commonwealth Fund.

These underinsured Americans face tough choices every month: Do they use their limited funds to pay for needed health care visits, therapies and procedures, or do they use that money for essentials like rent, utilities, child care and food?

Our sponsor, the HealthWell Foundation, believes that no American should go without essential medications and other therapies because they cannot afford them. The Foundation has helped more than 200,000 underinsured patients afford their medical treatments since its launch in 2004. As we recognize the fifth anniversary of the passing of the ACA, we want to know if you agree. Has the ACA helped you and your loved ones receive needed care, or are high out-of-pocket costs still keeping you from seeking the care you need? Let us know in the comments.