When the Affordable Care Act was passed in 2010, its supporters celebrated the legislation, calling it a landmark bill that would make Americans healthier and lower health care costs for families. Eight years later, it’s clearer than ever the ACA’s "Obamacare" exchanges have done quite the opposite. Not only are health care costs skyrocketing, the health insurance provided by Obamacare is so expensive for people to use that millions more Americans are now choosing not to go to the doctor — even when they’re sick or injured.
According to a survey by the West Health Institute and NORC at the University of Chicago, 47 percent of respondents said within the past 12 months they chose not to see a doctor or dentist because of the high cost of health care. Four-in-10 said they elected not to pursue a recommended medical treatment or test.
Even more disturbingly, 44 percent claimed they avoided seeing a doctor on at least one occasion while sick or injured because of costs. Twenty-nine percent said they chose not to see a doctor while sick or injured “more than once.” Forty percent said they are “extremely/very afraid” of getting “seriously ill” because of high health care costs.
The survey included only those who self-identified as insured. About two-thirds of respondents reported having private health insurance. Twenty-seven percent said they received their insurance from Medicare. Only 7 percent said they were enrolled in Medicaid.
These results are a dramatic departure from several similar surveys conducted over the past two decades. For instance, in 2014, the Associated Press and NORC conducted a survey that found only 19 percent of privately insured individuals choose not to go to the doctor because of costs. Only 18 percent said they avoided “preventive and recommended care.”
Similarly, a Gallup survey found in 2001 that 19 percent of Americans said they or a family member had over the previous 12 months “put off any sort of medical treatment because of cost.” In 2014, Gallup determined the answer to that question had risen to 33 percent, which is a remarkable increase but still 10 percentage points lower than the recent West Health-NORC survey.
Further, from the mid-2000s to the passage of the Affordable Care Act, there was virtually no movement in Gallup’s survey results on this question. Only after Obamacare was instituted did significantly more Americans begin to claim they had to stay away from their doctors, even while sick, because health care had become too expensive.
The sharp increase in the number of people avoiding their doctors is almost certainly the result of the increasing health insurance costs that have occurred in the wake of the Affordable Care Act’s passage. In 2018 alone, health care premiums for Silver Plans — the benchmark ACA insurance plan — sold on an Obamacare exchange increased by a shocking 31 percent, according to an analysis by Health Pocket. Health Pocket also reports the average Obamacare Silver Plan premium is now $477 for a 30-year-old and greater than $1,100 for 60-year-olds.
Premiums are just the tip of the Obamacare iceberg, however, especially because many people who purchase their insurance plans on Obamacare exchanges receive government subsidies. Deductibles — the total amount that must be paid out of pocket for many services before a health insurer picks up the full cost of a service — are a much better indicator of just how bad the Obamacare crisis has become.
The average deductible for a family purchasing a Bronze Plan on an Obamacare exchange is now $12,186. The average family Silver Plan deductible is $8,292, although the average maximum annual out-of-pocket cost for Silver Plan families is greater than $13,700.
With deductibles this high, health insurance for most lower- and middle-income individuals and families becomes useless, even if they are eligible to receive subsidies that help offset higher health insurance premiums.
The problem isn’t limited to Obamacare, either. The ACA imposed significant regulations, fines, and mandates that distorted the entire health insurance marketplace, causing health care costs to rise for everyone, regardless of whether they receive health insurance from an employer or from an Obamacare exchange.
It’s true that people enrolled in Medicare or Medicaid are partially immune to some of these health insurance cost increases, but they face plenty of unique health care challenges of their own. For instance, about 30 percent of doctors don’t accept new Medicaid patients, in large part because reimbursement rates are so low. In some states, such as New Jersey, research has shown a majority of doctors refuse to see new Medicaid patients. In many cases, finding a good specialist is particularly difficult for Medicaid recipients.
America’s health care system has had numerous problems for many decades, but Obamacare did nothing to fix them. Instead, it created an even more dysfunctional, bloated, bureaucratic model and forced everyone to join it or be greatly affected by it. Obamacare has been a complete and utter disaster, and without significant reforms, it will only get worse in the coming years.
Justin Haskins (Jhaskins@heartland.org) is executive editor and a research fellow at The Heartland Institute