Jon R. Gabel, Jeremy D. Pickreign, Heidi Whitmore
J. R. Gabel, R. McDevitt, R. Lore et al., "Trends in Underinsurance and the Affordability of Employer Coverage, 2004–2007," Health Affairs, June 2, 2009 28(4):w595–w606.
A study of trends in employer-sponsored health insurance found that plan enrollees’ out-of-pocket expenses grew by more than one-third between 2004 and 2007, affecting some 161 million Americans in all types of plans. Those who are sicker and poorer are often underinsured.
For many workers, health insurance is becoming prohibitively expensive, with premium shares and out-of-pocket medical expenses steadily rising. Some economists and actuaries claim, however, that employees do not have enough "skin in the game"—that higher patient cost-sharing is needed to prevent overuse of health services and keep health costs under control. Jon Gabel and colleagues analyzed medical claims and health benefits survey data to better understand changes in the financial protection workers with insurance have, their out-of-pocket expenses, the affordability of coverage, and underinsurance rates.
Many health plans provide adequate financial protection for individuals with higher incomes. But for people with moderate to low incomes, particularly the poor and the sick, the rise in overall health care costs is making insurance—and care itself—unaffordable. The study’s findings highlight the need for public policies aimed at controlling health care costs and ensuring that everyone has access to affordable health coverage.
The researchers simulated health plan and out-of-pocket spending from 2004 to 2007 using medical claims from the MarketScan database, which includes some 10 million individuals with employer-based insurance. These data were used to calculate what members would pay for the same services under each kind of plan: HMO, point-of–service plan, preferred provider organization, and high-deductible plan with savings options. Plan information came from the 2007 Kaiser Family Foundation/Health Research and Educational Trust health benefits survey.
A growing number of Americans enrolled in employer-sponsored health plans are dealing with substantially higher premium and other out-of-pocket costs, largely because of the growth in health care costs overall. Even if benefit packages hold steady, without health system reform, more people will be underinsured or unable to afford any coverage at all.