2 of 5 adults younger than 65 fear they can’t afford health care

Forty-three percent of adults ages 19 to 64 reported that cost prevented them from going to the doctor or filling prescriptions, according to the Commonwealth Fund’s 2012 Biennial Health Insurance Survey (link).

That was up two percentage points from 2010. The overall number reflected two trends. One was that the rate of adults ages 19 to 25 reporting cost as a barrier to access went down — a result, the Commonwealth Fund said, of an Affordable Care Act provision that allowed those younger than 26 to stay on their parents’ insurance. The other is that outside that age group, cost grew as a barrier, not only because of trouble for some in getting or staying insured, but also because growth in deductibles put more of an onus on insured patients to cover some of their bills.

The survey found that 79% of young adults in 2012 were insured, compared with 69% in 2010. The increase means that 3.4 million more people ages 19 to 25 got health care coverage. The provision expanding the age at which young adults could stay on their parents’ insurance was one of the first ACA rules to go into effect.

Effect of rising deductibles

The Commonwealth Fund reported that 30% of adults ages 19 to 64 were uninsured at some point in 2012. An additional 16% were underinsured, meaning out-of-pocket expenses exceeded at least 10% of income (or 5% if adults were under 200% of the poverty line), or deductibles equaled at least 5% of income. The organization reported that the insured were paying higher deductibles. The percentage of those with a deductible of $1,000 or more has more than tripled during the past decade, from 7% in 2003 to 25% in 2012.

Other organizations, such as the Centers for Disease Control and Prevention’s National Center for Health Statistics and Gallup, have noted similar rates of adults having trouble accessing care because of costs.

The Commonwealth Fund, which supports the ACA, said its numbers show that it’s “imperative for federal and state policymakers to complete the rollout of the law’s central coverage provisions,” such as expanded eligibility for Medicaid; a ban on insurers charging more to patients because of health, gender or preexisting conditions; and no co-pays for insured people to get certain preventive care.

In 2014, an additional 14 million adults are expected to become insured when the ACA requires adults to buy insurance or pay a penalty, with lower-income Americans getting assistance to buy plans.

But as of this article’s deadline, 26 states have no plans to accept a federal match to cover additional coverage costs for expansion of Medicaid eligibility up to an effective rate of 138% of the poverty level. After three years, states will pick up 10% of the expansion costs.