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Millions of U.S. workers can’t afford health insurance PDF Print E-mail
Sunday, May 19, 2013 10:46 PM


Staff writer

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DELPHOS — A huge number of Americans are abandoning much-needed medical care because they can’t afford it.

According to the Commonwealth Fund’s Biennial Health Insurance Survey, an estimated 80 million people, close to 43 percent of America’s working-age adults, did not go to the doctor or access other medical services in 2012 due to cost. That figure is up from 75 million people two years ago and 63 million in 2003.

Eighty-four million people nearly half of all working-age U.S. adults went without health insurance during part of 2012. Some had out-of-pocket costs that were so high relative to their income they were considered underinsured.

Principal/Broker for Fortman Insurance Service, Inc., Jonathan M. Fortman said insurance rates have been going up and it’s a big issue. He agrees that something needs to be done to stabilize insurance rates.

“Many people have been purchasing limited medical coverage through indemnity plans because of the affordability,” Fortman said.

Last year, three in 10 adults said they did not visit a doctor or clinic when they had a medical problem, while more than a quarter did not fill a prescription or skipped recommended tests, treatment or follow-up visits. One in five said they did not get needed specialist care.

And 28 percent of those with a chronic condition like hypertension, diabetes, heart disease and asthma — who needed medication for it — reported they did not fill prescriptions or skipped doses because they couldn’t afford to pay for the drugs.

In addition, more than 41 percent of the adults ages 19-64 — 75 million people — reported problems paying their medical bills or were paying off medical debt over time.

People with good coverage find themselves spending more and more on deductibles and co-payments and those with deductibles greater than $1,000 more than tripled between 2003-12.

The Obama administration says the Affordable Care Act [ACA] will provide cheaper health insurance for millions of Americans.

Premiums for insurance through the exchanges depend on a variety of factors—income, age, gender, current coverage level, smoker verses non-smoker and state of residence—and the exact cost of plans will not be known until the exchanges open for enrollment on Oct. 1.

Fortman said that people participating in the market plan coverages will have the opportunity to pick from different plans.

“The government has set up Catastrophic, Bronze, Silver, Gold and Platinum plans,” Fortman detailed. “Each metal has a certain actuarial value.”

The actuarial value is the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70 percent, on average, the insured would be responsible for 30 percent of the costs of all covered benefits. The actuarial percentage values of the plans are; Bronze, 60 percent; Silver, 70 percent; Gold, 80 percent; and Platinum, 90 percent.

The Catastrophic Plan has a lower cost associated with it and is available to people 30 years old or younger. The catch is, it has a much higher deductible.

“These are the ‘young invincible’ with low premiums but higher out-of-pocket costs,” Fortman explained.

Older Americans, who tend to have more health issues, will probably see their premiums go down since they will be mixed into a risk-pool with younger, healthier people. The ACA limits the amount insurers can charge older enrollees to three times the amount charged for younger participants. At this time, older folks are charged five times that of their younger peers.

Fortman said the current rate structure in Ohio varies with age. After the ACA takes effect, the risk-pool will consist of all ages and levels the playing field. For example, at this time, a 25-year-old may pay $100 per month and a 60-year old may pay $600, but after the first of the year, those two individuals would receive a community rating. The 25-year-old pays $100 and the older individual will pay up to $300.

“The older individual would not pay more than three times the difference in rating,” Fortman explained.

It is estimated that 57 percent of enrollees — those with incomes of 400 percent of the poverty line — will receive subsidies covering close to two-thirds of the premium.

Although it’s not yet official, Ohio is planning to expand Medicaid coverage, which would extend free medical coverage to almost 700,000 Ohioans with incomes that meet the federal poverty guideline of 133 percent.

Another issue the ACA has eliminated is insurance companies charging customers differing premiums based on gender. Men typically pay less than women, since they visit the doctor less frequently. After the first of the year, men ages 25-36 may see a spike of 50 percent and women of the same age may see an increase of four percent. In addition, men age 60-64 could see their premiums drop by 12 percent.

Fortman explained that with the ACA in place, insurers must provide a basic suite of Essential Health Benefits, including; maternity, pediatric and mental health care; preventative routine annual screenings such as mammograms, PSA and colonoscopies; and prescription coverage. These benefits will be covered by all plans with no out-of-pocket expense or annual or lifetime limits for the insured.

“It will be interesting to see how it all plays out,” Fortman said. “We [insurance companies] are continually getting new information, attending webinars and requesting guidelines.”

Download the Application for Healthcare Coverage & Help Paying Costs at

Last Updated on Monday, May 20, 2013 12:02 AM

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