Image may be NSFW.
Clik here to view.
The first installment of the Triple Aim of health reform points to Access. For some that means access to affordable insurance, while others insist that definition needs to be broader and refer to affordable access to health care. Experts are starting to question whether the ACA’s expansion can deliver on the promise of true affordability simply by subsidizing health insurance purchases to the lower income strata of American society. Instead, these experts contend that while 30 million Americans may gain health insurance over the decade, many of those individuals will not have benefits comprehensive enough to cover their needs and mitigate out-of-pocket spending.
Concerns about rates of medical bankruptcies continues. Even with insurance, literature shows that many individuals remain underinsured, leading to personal bankruptcy, often due to overwhelming medical costs.
On the newly forming Health Exchanges, individuals will have a choice of bronze, silver, gold, or platinum level plans. Bronze will cover 60% of an average enrollee’s medical costs, meaning an individual would be expected to share in 40% of the costs in the form of co-pays, co-insurance, and deductibles. Federal authorities are projecting that the vast majority of lower income individuals will purchase silver plans, which cover 70 percent of the actuarial value – the minimum level of plan comprehensiveness for which the premium subsidies kick in.
The bigger picture is that consumers need to be educated on total health care costs, not just insurance premiums. Tools to calculate expected or potential cost-sharing would go a long way in creating informed consumers who can better control their health care choices and costs.
