- Despite historic gains in the share of working Americans who have health insurance, many remain uninsured or underinsured, according to a survey of 8,022 adults published Sept. 29 by the Commonwealth Fund.
- A total of 43% of respondents were inadequately insured in 2022, 23% of whom were underinsured. The survey defined underinsured persons as those to whom one of the following applied: out-of-pocket costs in the past year were 10% or more of household income; out-of-pocket costs in the past year were equal to 5% or more of household income for those living under 200% of the federal poverty level; or the deductible constituted 5% or more of household income.
- Of those with employer-sponsored health coverage, nearly one-third were underinsured, per the survey. Of underinsured adults, 44% had a medical problem but did not visit a doctor or clinic, 43% skipped a recommended test, treatment or follow-up due to cost, 40% did not get needed specialist care and 31% did not fulfill a prescription.
Employers have looked to their healthcare benefits in the push to attract scarce talent, a trend which may continue for the foreseeable future. According to Willis Towers Watson survey data published in April, 64% of U.S. employers were planning to address healthcare affordability over the next two years.
Those efforts could become complicated due to rising costs. Consulting firm Mercer’s recent survey of health benefits found that the average health benefit cost per U.S. employee is expected to increase by 5.6% in 2023, up from a projection of 4.4% for 2022.
Chronic condition management could prove especially costly next year. The Business Group on Health found that 44% of large employers said they expected a higher prevalence of late-stage cancers in their employee populations due to delayed preventative screenings.
The Commonwealth Fund survey noted that low-income adults, whether they are covered by employer-sponsored coverage or other coverage, were underinsured at higher rates than their higher-income peers. The same was true of patients with health problems, who were more likely to be underinsured than healthier people.
“The high cost sharing people face in many employer, individual-market, and marketplace plans is primarily driven by the prices that providers, especially hospitals, charge to commercial insurers and employers,” according to the report. “These prices are the highest in the world. And consumers bear the burden, in the cost of their insurance, the size of their deductibles, their out-of-pocket maximums, and their copayments.”
Other research posits other explanations of why out-of-pocket costs have increased for employees. Last month, the Employee Benefits Research Institute found that the share of out-of-pocket costs shouldered by workers grew from 17.4% in 2013 to 19% in 2019. EBRI said that higher utilization of high-deductible health plans may be fueling increased cost sharing.
Meanwhile, some employers have redesigned their plans in order to address costs, such as by introducing or expanding care navigation services and value-based care arrangements, sources previously told HR Dive.