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Who Can’t Pay for Health Care? – PMC

In an era of rising health care costs and budget constraints, an increasing number of Americans are struggling to pay for necessary health care services. among the uninsured, finding a provider that offers affordable services is challenging at best, and the wait for an appointment with a provider that offers free or reduced-price services can be considerable.1 for those with coverage Medicaid, state budget restrictions may affect your eligibility for coverage, the services offered, or your ability to find a provider willing to accept the Medicaid fee schedule.2 Those with Medicare face copays and bear rising prescription drug costs. .3 Even private policyholders may face difficulties paying for care with rising premiums, deductibles, and copays, and private plans that may not cover an adequate amount of their costs to ensure access to quality health care.

An indication of potential difficulties in paying for care may come from such changes in private insurance coverage: 68.6% of Americans were covered by private plans in 2003, and 60.4% were covered by employer-sponsored plans, which represents a small but significant decrease from 2001 levels of 70.9% and 62.6%, respectively.4,5 while the average increase in the cost of employer-sponsored benefits was lower in 2003 than in 2002 ( 10.1% vs. 14.7%), employee contributions to premiums increased sharply, deductibles and out-of-pocket maximums increased, copays increased, and many employers reduced covered services.6 With health care costs rising and expected to continue at rates above 7% per year for the next 5 years,7 such potential changes in private insurance plans and public programs may negatively affect the ability of Americans to pay for care.

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Reading: Who can afford health insurance

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Medicare spent more than $252 billion in 2002 to pay for health care for people age 65 and older and certain disabled people.8 In addition, many Medicare enrollees age 65 and older buy medigap plans, which are designed to help cover out-of-pocket expenses and provide additional insurance coverage. The Medicare Prescription Drug, Improvement and Modernization Act of 2003, which for the first time provides prescription drug benefits under Medicare, is intended to help reduce out-of-pocket drug costs for members.9 However, its effects can be limited, given the sharp increases in prescription drug prices that followed the signing of this law.3 In addition, Medicare+Choice, the program’s managed care option, continues to pass on more costs to enrollees,10 although the increase in Payments to these plans included in recent Medicare plans reform legislation may affect this trend. Overall, then, it’s not clear to what extent Medicare beneficiaries are likely to struggle to pay for care in the future.

Medicaid generally covers the full cost of covered services or requires only a nominal copay and excludes providers from “balance billing,”11 potentially reducing members’ problems paying for care. however, ku and nimalendran find that to address state budget gaps totaling $78 billion for fiscal year 2004, 34 states have cut funding from their public health insurance programs. They estimate that between 1.2 and 1.6 million low-income people will lose coverage through Medicaid and the state children’s health insurance program as a result of eligibility cuts, increased enrollment barriers, premiums higher rates and an enrollment freeze. those who manage to retain public coverage may face a program with reduced payments to providers (possibly resulting in fewer participating providers), prescription drug restrictions, or increasing limits on covered services.2

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During the economic boom of the 1990s, the uninsured rate for adults under 65 was largely flat.12 However, the uninsured rate has been on the rise since 2000, and The growth in the number of uninsured in 2002 represented the largest single-year change since 1987.13 A total of 45.0 million Americans were uninsured in 2003, compared to 43.6 million in 2002 and 41.2 million in 2001.4,5 Along with rising health care charges,14 there are likely more uninsured people who have increased difficulty paying for needed care. this is a particular concern, given a substantial body of literature documenting the negative health consequences of being uninsured.15,16

Recently, calls for universal health insurance coverage have been renewed in the United States.17 While such coverage would help those who are currently uninsured, to the extent that they may still have trouble paying for care with insurance public or private is unknown. Data from the Centers for Disease Control indicates that 6.8% of adults reported problems paying for care despite having public or private health care coverage.18 In this article, we use a unique data set that provides estimates of the number of American adults who avoid health care due to cost and their personal characteristics, including health insurance coverage. We also present information on the extent to which people who have health insurance coverage nevertheless report avoiding health care due to cost concerns. In addition to focusing on income levels, this latest analysis emphasizes functional status, as avoiding medical care due to cost may have particular health risks for people with functional limitations.

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