The Affordable Care Act created an individual market with premium subsidies on par with the dominant employer-based market, but the new plans are more likely to have high deductibles, according to a new Commonwealth Fund survey.
However, based on the annual Kaiser Family Foundation employer health benefits survey released this week, rising deductibles have become a widespread issue. Roughly half of all workers in employer plans have an annual deductible of at least $1,000, and the average deductible has grown at almost seven times faster than wages.
The Commonwealth Fund surveyed almost 5,000 adults with ACA exchange or employer coverage and found that the costs of premiums were relatively similar. Roughly 60% of those with ACA plans either paid no monthly premium or less than $125, compared with 55% of people with employer plans. Employers subsidize the vast majority of their workers' health insurance premiums, and the government offers subsidies for the millions of Americans now enrolled in coverage through the exchanges.
Although deductibles and out-of-pocket obligations are rising in all plans, it's especially true for those with ACA coverage. About 43% of the enrollees had deductibles of $1,000 or more, compared with 34% of employees with health insurance, according to the Commonwealth Fund. It's not uncommon for an individual ACA plan to have a deductible of at least $5,000 or more, which has proved unaffordable for many low-income people.
“Affordability is obviously a very key issue,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund, during a call with reporters.
The not-for-profit think tank estimates 25 million people still lack health insurance, yet are eligible for some kind of ACA plan or Medicaid. HHS said this week that 10.5 million people are eligible specifically for marketplace plans in the upcoming open-enrollment period, which starts Nov. 1.
HHS Secretary Sylvia Mathews Burwell has said this year's open enrollment, the third under the ACA, will be the toughest yet since many people who needed health insurance the most have already purchased it. For those who haven't, the affordability of premiums and out-of-pocket costs appear to be the biggest hindrances.
However, 54% of adults who did not enroll this past year had incomes that would have made them eligible for the premium tax credits. “It is unclear whether the subsidies are insufficient across income levels to help all those eligible enroll or whether there is a lack of clear information about the subsidy assistance and the actual net costs of insurance to potential enrollees,” according to a Commonwealth Fund report on the survey results.
