More Americans struggle to pay health care costs, even with insurance plans

SALT LAKE CITY — For Salt Lake City resident Anna West, changes in health care coverage have significantly shaped her adult life.

“As a woman with a chronic illness, I’ve been chasing health insurance since I was 20 years old. All my decisions revolve around health insurance,” she said.

But even with a health plan through the Affordable Care Act, she finds herself struggling to pay for medical care.

And increasingly, West isn’t alone. 

A new nationwide report indicates that many U.S. residents who routinely pay for health insurance can’t afford to use it.

According to the Commonwealth Fund’s 2016 Biennial health insurance Survey released last week, more Americans are joining the ranks of the underinsured, meaning they can’t afford to use the health insurance for which they routinely pay.

West suffers from a rare genetic condition called Ehlers Danlos syndrome, and due to a 2013 surgery that damaged her vagus nerve, she also battles gastroparesis.

Ehlers Danlos syndrome is a group of disorders that affect connective tissues — skin, joints and blood vessel walls, and gastroparesis is a condition that impedes the normal movement of muscles in the stomach, according to the Mayo Clinic.

West estimated that between 20 to 40 percent of her income goes to health care.

“My premiums are about $110 per month and medication is $200 to $250 per month,” West said. Doctor visits can climb as high as $300 some months, she added.

But without coverage, West said her prescriptions would be out of reach.

“I’d have to go off all my medications . . . and without those I wouldn’t be able to work. Really I”m investing in the economy because it allows me to keep contributing,” West said.

“I’m not sick enough to be on disability, but not well enough to go back to what I did before,” West said, adding that she holds bachelor’s and master’s degrees in public health from Utah State University and worked for Utah’s Department of Health for a decade, followed by a stint in advertising and public relations with an agency that has since shut down.

West now works as an adjunct instructor for Salt Lake Community College teaching dance and health courses — a job she loves — and hopes to take on another part-time job that offers health care benefits. For a while, she tapped Utah’s COBRA coverage until she could sign up for an Affordable Care Act plan

“My deductible is $2,000 a year, so what ends up happening is that none of my doctors’ visits are covered,” West said. “I’ve never met my deductible, So the ACA really just pays for my prescriptions.” 

West said she sees a doctor for pain management every month and makes at least two visits per year to her neurologist, which is not covered by her plan, for migraines. She also participates in two to three weeks of physical therapy twice per year. 

Her coverage does not include vision and dental insurance. “I had a filling fall out a few weeks ago, and I’m just waiting, I’m delaying care on that,” West said.

Uptick in the underinsured

“As the problem of underinsurance gets worse, people with coverage will increasingly face problems similar to those of the uninsured,” said David Blumenthal, president of the Commonwealth Fund, a national philanthropic foundation that researches health and social policy issues. He and Sara Collins, Commonwealth’s vice president for health care coverage and access presented the report’s findings during an Oct. 17 teleconference.

According to the survey, someone is underinsured if their out-of-pocket costs for the past year — not including premiums and deductibles — equaled 10 percent or more of their household income, or 5 percent or more for those under 200 percent of the federal poverty level — $23,760 for one adult or $48,600 for a family of four. They also qualified as underinsured if their deductible consumed 5 percent or more of their household income.

For surveyed adults ages 19 to 64, 28 percent were underinsured in 2016, compared to 12 percent in 2003. High deductibles relative to income played a significant role in this steady uptick.

The underinsured reported difficulty in paying medical bills, with 51 percent struggling in similar fashion to the 53 percent who had no insurance at all. About 38 percent of the underinsured took out credit card debt to cover medical costs, with 40 percent of that group reporting a drop in their credit rating.

Also, roughly 45 percent of underinsured adults with high deductibles skipped seeing a doctor when they got sick, didn’t fill prescriptions or avoided recommended tests or treatments due to out-of-pocket costs. About 52 percent of uninsured adults surveyed also reported doing those things.

According to Collins, Princeton Survey Research Associates International conducted the survey of 6,005 adults by landline and cellphone from July 12 to Nov. 20, 2016. The analysis and report focused on those who had been insured for a full year at the time of the interview.

President Donald Trump has long had the Affordable Care Act — commonly called Obamacare — in the crosshairs, urging the Republican-controlled Congress to repeal and replace it as quickly as possible. But so far, they’ve been unable to accomplish that task. On Oct. 12, Trump announced he would eliminate federal subsidies that lowered insurance deductibles for low-income households, a move that attracted legal challenges. Congressional action can also override Trump by appropriating funding for those subsidies.

RELATED: Trump's blow to 'Obamacare' jolts health consumers, politics

Nevertheless, Trump’s actions have disrupted the insurance markets. His administration also cut the ACA enrollment period in half this year — it opens Nov. 1 and closes Dec. 15.

“The critical issue for the 2018 enrollment period is the uncertainty that this places in the mind of consumers who are getting ready to enroll,” Collins said. “It’s important for people to know that these changes for the most part won’t affect their plan choices for 2018 ... and that they need to go ahead and renew their policies or enroll for the first time if they don’t have a plan.”

But by 2019, the insurance landscape could look quite different. What it will become remains a mystery.

Opting out of the game

In this time of health insurance uncertainty, one Ogden man chose to go a different route.

“I canceled my health insurance coverage a year and a half ago because the premium went up so fast and high. I haven't exceeded the deductible in 23 years, yet I got no credit for being a good steward of the benefit — and I couldn't take it anymore,” Richard Hyer said recently in a Facebook post.

Hyer, an Ogden City Council member, made it clear he was speaking as a private citizen and not in his capacity as an elected official. Instead of continuing to pay more in premiums, deductibles and out-of-pocket costs, Hyer and his wife chose to test-drive a bill sharing group called Christian Healthcare Ministries.

According to, for more than 35 years the organization’s framework has helped Christians give each other a hand with medical bills. The website claims they’ve shared over $2.5 billion in mutual health care costs so far.

The bill-sharing nonprofit offers different program levels of participation, and Hyer said he and his wife pay a combined $300 per month for the gold plan that covers some prescriptions and has a $500 deductible per incident for service costs.

“They’re not an insurance company, and they don’t back us up. But when we go to the doctor, we ask for the rate and cash price, and they typically give us 30 to 40 percent off the rate they charge the insurance company,” Hyer said. “If people started to shop for health care the way they do for a car, it would encourage competition in the marketplace and they’d be much more informed users of their health care.”

By utilizing the bill-sharing option, Hyer said he was also able to avoid paying a penalty under the Affordable Care Act. He also urged people to note the difference between affordable health care and affordable insurance — even though the two terms get rolled into one monumental issue that appears nearly impossible to resolve.

Utah’s shrinking marketplace

The Utah Health Policy Project presented an analysis of Utah’s 2018 insurance marketplace during an Oct. 11 Health Reform Task Force session at the state Capitol. Utah is one of 19 states that chose not to expand Medicaid, a key component of the Affordable Care Act.

RELATED: Full Medicaid expansion could go to voters to decide in November 2018

Since ACA coverage became available in 2014, Utah’s uninsured rate for all ages dropped from 12.5 percent to 8.8 percent. In 2014, the marketplace offered 91 plans through six insurers. In 2015, those same six insurers remained on board, expanding available plans to 101. But in 2016, the decline started where four insurers remained and plans decreased to 74, with Select Health — the insurance division of Intermountain Healthcare — dominating the market with 60 of the available 74 plans.

In 2017, three insurers remained with 28 plans, and looking forward to 2018, Utahns are left with Select Health 24 plans or University of Utah’s four plans.

Marketplace subsidies this year covered 72 percent of average monthly premiums for Utah enrollees, and 62 percent received cost-sharing reductions that reduced their deductibles and co-pays.

During that same Task Force session, representatives of the Utah Insurance Department predicted that in 2018, rates in the individual market will spike 40 percent over 2017, and rates in the small group market will increase by 10 percent. The 2018 increases are based on the assumption that the federal government will no longer fund cost sharing subsidies for ACA participants.

People seeking to renew their marketplace insurance or enroll for the first time can find assistance at or by calling 2-1-1.

Contact reporter Cathy McKitrick at 801-625-4214 or Follow her on Twitter at @catmck.  

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