Real World Health Care Blog

Tag Archives: deductibles

Implementation of Health Care Law Expanding Coverage to More Young Adults

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Linda Barlow

For the first time in nearly a decade, the number of 19-25 year-olds gaining access to health insurance is on the rise, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey. Researchers point to a provision in the 2010 Patient Protection and Affordable Care Act (PPACA or ACA), which allows young adults to stay on their parents’ health insurance until age 26, as a likely cause of this groundbreaking trend.

“The early provisions of the Affordable Care Act are helping young adults gain coverage and improving the affordability of health care during difficult economic times for American families,” said Sara Collins, Ph.D., a Commonwealth Fund vice president and lead author of the Biennial Survey’s report, Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act.

The improvements in young adult health coverage are significant, according to the Biennial Survey:

  • Nearly eight in 10 (79 percent) of Americans ages 19-25 reported that they were insured at the time of the survey in 2012, up from 69 percent in 2010, or a gain in health insurance coverage for an estimated 3.4 million young adults.
  • The share of young adults in this same age group who were uninsured for any time during the year prior to the survey fell from 48 percent in 2010 to 41 percent in 2012 – an estimated decline of 1.9 million, from 13.6 million uninsured young adults in 2010 to 11.7 million in 2012.

Of the estimated 3.1 million young adults who are now covered through the ACA, 60 percent are leveraging it for mental health, substance abuse, or pregnancy treatment, according to a study from the Employee Benefits Research Institute (EBRI). For one large, national employer profiled in the study, the newly-covered young adults used about $2 million in health care services in 2011 – about 0.2 percent of the employer’s total health spending.

Access is a major barrier to care for young adults, who were previously terminated from their parents’ plans when they turned 19. According to the Henry J. Kaiser Family Foundation (KFF), young adults typically face difficulties obtaining their own coverage because they work in entry-level, low-wage or temporary jobs that are less likely to provide health insurance. Lack of insurance makes it harder for young adults to receive adequate medical care –  a problem that plagued one in five young adults before the ACA began to take effect.

“Young adult women have additional health needs and are particularly vulnerable when they are uninsured, as they are at an age when they require reproductive health services,” noted Karyn Schwartz and Tanya Schwartz, authors of KFF’s Issue Paper, How Will Health Reform Impact Young Adults? “Having health insurance and consistent access to the medical system may increase the likelihood that they receive timely pre-natal care if they become pregnant.”

Meanwhile, some skeptics are expressing concerns about key aspects and implications of the Act, from objecting to young single males being required to purchase a plan including maternity benefits and well-baby coverage – to others saying that full implementation of the ACA in 2014 will mean much higher premiums for young adults. Many have challenged these assertions, however, noting that the ACA’s age-based pricing requirements are largely in line with premiums individuals are paying now.

Although the news for young adults is mostly good, the survey also found that 84 million people – nearly half of all working age U.S. adults – went without health insurance in 2012, or faced out-of-pocket costs that were so high relative to their income that they were considered “underinsured.”

The survey did indicate that 87 percent of the 55 million uninsured Americans in 2012 are eligible for subsidized health insurance through the insurance marketplaces or expanded Medicaid under the ACA. Up to 85 percent of the 30 million uninsured adults also might be eligible for either Medicaid or subsidized health insurance plans with reduced out-of-pocket costs.

Click here to learn more about pricing options for young adults seeking health insurance coverage.

Now it’s your turn. Does rollout of the ACA mean more accessible and affordable health insurance coverage, or will it drive up costs, particularly for younger Americans? Get the conversation started.

Categories: Access to Care

Heroes Needed: Apply Within

We’re taking a departure today from our coverage of what works in American health care to ask for your help.

Patients want us to re-open our Breast Cancer Fund at HealthWell, but we can’t successfully do that until we identify several key companies or organizations to partner with us in this effort.

When HealthWell’s Breast Cancer Fund was open, thousands of Americans battling breast cancer found new hope to live healthier lives. Nearly 17,000 insured breast cancer patients received the financial assistance they needed so that the surging cost of treatments was not a barrier to accessing critical care.

As HealthWell prepares to re-launch its massive Breast Cancer Fund, we are expanding our call to action. We are seeking partners to help us make a real, positive difference in the lives of insured patients who often struggle to afford critical treatment including medications.

By becoming a strategic partner with the HealthWell Foundation, your organization will help thousands of Americans who face medical bills they can’t afford.  Beyond the incredible satisfaction of knowing that you played a role in persuading your organization to help us re-open this fund, you’ll gain a cause marketing partner that will support your efforts to build and shape your brand to new audiences.

When you work with us to empower patients, you will leverage a unique opportunity to win exclusivity, naming rights and more.

With one in eight women in the U.S. expected to develop breast cancer during her lifetime, the need for timely, life-sustaining care is outpacing our health system’s ability to assist patients. More and more Americans are in desperate need of immediate financial relief to afford deductibles, co-pays and premiums, yet many have few places, if any, to turn for assistance.

Women like Linda in Powell, Tenn., illustrate exactly why support for the Breast Cancer Fund at HealthWell is needed. When Linda realized just how expensive her breast cancer medication would be, she was scared. As a self-employed grandmother of two, she faced a $5,500 deductible for her insurance premium alone. Additional costs for mammograms, colonoscopy, endoscopy and lab work were all out-of-pocket and she wasn’t sure how she would make ends meet.

That is, until she discovered the Breast Cancer Fund at HealthWell, a lifeline that enabled her to afford the treatments she needed to remain cancer-free two years after her diagnosis.

“My patient advocate gave me a list of several foundations to contact which I did,” Linda said. “The first turned me down because they said we went $50 over our salary. The second turned me down because I had a deductible. Then I heard from HealthWell. We couldn’t believe we had found help. We just had to cry. I am so thankful. Every time I have my prescription filled it still amazes me. Not many good things have happened to us.”

The fund’s incredible track record of success in offering assistance to patients in need is exactly why we must reopen it now.

The HealthWell Foundation believes that no patient – adult or child – should go without health care because he or she cannot afford it. As demand for medical treatments increases while associated prices continue to spike, we want the Breast Cancer Fund at HealthWell to once again provide timely, critical copay and premium assistance and expanded services to breast cancer patients.

These services went far to ease the strain felt by patients covered under Medicare, Medicaid, private insurance and employer-sponsored plans with incomes up to 400% of the federal poverty level.

Strengthening the financial safety net for more patients begins with teamwork. Together we can be part of the solution, harnessing our resources to make access to quality medical treatment a reality for more Americans battling breast cancer. Please contact us if your company may be interested in partnering with us to re-open this vital fund.

The HealthWell Foundation sponsors this blog because we are innovators in finding solutions to overcome hurdles in the American health care system. The thousands of women at work right now trying to clear the hurdle of breast cancer deserve everything we have to give.  Join us.  We have so much yet to do.  And you could make a difference in so many lives.

Categories: Cost-Savings