Things that are not a surprise, #1: Health insurance is not the complete solution

Last updated on: February 26, 2015 at 10:55 pm by Jane the Actuary

Things that are not a surprise, #1: Health insurance is not the complete solution 2015-02-26T22:55:56-06:00 Jane the Actuary

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Remember VoucherCare? No — not the pejorative label used by Democrats to criticize the Paul Ryan plan for Medicare, but my Obamacare-alternative from one of my very first posts. OK, it’s not a surprise that no one read it when I was pretty much writing in a vacuum (except for an early, and generous, Ann Althouse shout-out).

Anyway, I had said that, to avoid the perverse incentives of the existing structure of the subsidies, I’d just have tax-funded vouchers for everyone, sufficient for a high-deductible plan (with the voucher amounts variable by age and sex). But I presumed that “sliding-scale clinics could provide care for those who can’t afford the out of pocket costs up to the deductible.” And my original post didn’t detail this, but I took it as a given that these clinics would need to be fairly widely available — and, even so, considered the affordability of pre-deductible out-of-pocket care for low-income people to be a significant deficiency of any such proposal. (And have had reason to consider this anew each time, this year, that we’ve been to the ER, for stitches for my youngest, twice, and for the removal of a deep splinter for my middle son.)

Now the Tribune is just discovering this, in an article in today’s paper, “Some newly insured still struggle to pay for health care.”

[Those insured on the Exchanges] who picked plans with the lowest monthly costs have found that medical care is still out of reach because of the plans’ high deductibles. As a result, many consumers with high-deductible plans are following old habits: delaying care or taking their needs to community health centers that have traditionally served the uninsured, local health administrators said.

. . .

Officials have cited the number of people who signed up for private insurance last year as a measure of the federal health law’s success. About 217,000 Illinoisans signed up, exceeding federal expectations, and about 7.1 million Americans enrolled during the law’s first open enrollment period. But about 63,000 Illinoisans enrolled in low-premium bronze plans, which last year had a median deductible of $5,600 in the state and for 2015 have a median deductible of $5,750.

Which is a lot of money if you’re just barely able to meet your day-to-day expenses.

. . .

Like other free and charitable clinics, Family Health Partnership traditionally served the uninsured. But this year the clinic changed its policy to accept people with insurance who can’t afford care, said Hoban, the clinic’s director.

“This is a paradigm shift for us,” she said.

CommunityHealth, a Chicago-based free clinic that serves 11,000 patients, is considering making a similar change next year, said Judith Haasis, CommunityHealth’s executive director.

To state the obvious, it should not have been a surprise that people with high deductible health plans will still need free and sliding-scale clinics. In fact, it’s a surprise to me that these people are surprised in the first place. After all, Illinois’ Early Intervention program to provide therapy to children under age 3 who aren’t hitting developmental milestones (after 3, this occurs via school programs) covers both uninsured children and those with high deductibles or other out-of-pocket costs, as a secondary payer, and I had pretty much assumed the sliding-scale clinics would do likewise.

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