Health Center News

Going Without Care

The Commonwealth Fund
The Commonwealth Fund

Lately, we’ve been reading a lot about people who put off seeking care because they can’t afford it, even with insurance.  A case in point is an article that features 60-year old Jay Korobow in New Jersey.  Korobow suffers from high blood pressure and checks his blood pressure at a local drug store.  And what if the blood pressure reading is too high?  “I self-treat myself,” he tells the reporter with

Earlier this fall The Commonwealth Fund found that about 40 percent of adults with high-deductible private insurance plans were putting off care because they could not afford it.  The study (“Too High A Price: Out-of-Pocket Health Care Costs in the United States“) also found:

  • More than one of five 19-to-64-year-old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, 13 percent spent 10 percent or more.
  • Adults with low incomes had the highest rates of steep out-of-pocket costs.
  • About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford.

We also reported on this trend in Community Health Forum magazine, just out this week. Of the more than 7 million people who bought coverage on the federal and state exchanges, about 20 percent chose the bronze plans that include deductibles as high as $5,000 per person, according to Modern Healthcare.

That is where Community Health Centers come in — and why ensuring continued funding to meet the demand for care is critical.  Health centers are essentially “subsidizing” the bronze plans because these underinsured are counting on them for discounted care and the plans won’t reimburse health centers until the patients have met their deductibles—which may well be out of reach for many health center patients.  Compounding financial strain for health centers is the fact that private insurance only reimburses them on average of about 56 cents on the dollar (compared to 81 cents on the dollar for Medicaid patients).

“Health centers have a long history of supporting a coverage expansions of all types–but yet again, as the provider on the front lines, health centers are seeing that coverage does not necessarily equate to access to needed care,” said Dan Hawkins, NACHC’s Senior Vice President for Public Policy and Research.  “While health centers stand ready to meet the growing demand for care, unless the health center primary care funding cliff is fixed and new Qualified Health Plans pay health centers adequately, there will be a grievous strain on health centers already-limited resources.”