American Council for a National Health Service
Wire Services
Across the nation healthcare affordability is one of the greatest concerns for United States citizens. In the past few years health insurance companies have been promoting and providing, “Metal Levels”, different health insurance tiers designated as, “Bronze”, “Silver”, “Gold”, and “Platinum”. Even though multiple sources have made it known that these tiers do not represent quality there are other negative aspects to these plans especially when considering the costs for low-income patients.
It has been an ongoing issue of how Metal Level tier premiums (monthly payments) and deductions (out-of-pocket payments) disproportionately and negatively affect low-income patients. Studies conducted by The Commonwealth Fund have found that the “most affordable” tiers have a trade off that consists of an extremely illogical practice of having low premiums, but high deductibles. It was also shown even with the help of Community Resource Specialists (CRSs) that a large number of low-income patients still fall through the cracks with no safety net. The Commonwealth Fund stated in the conclusion of their study that,
“Our analysis demonstrates that marketplace plans with the lowest premiums — both silver and bronze — typically impose substantial financial barriers through high deductibles and out-of-pocket maximums (although most plans cover primary care and other physician services, with copayments, before deductible are met). The most affordable silver plans generally carry deductibles of $5,000 or more, while similar bronze plans exceed $7,000, and out-of-pocket maximums typically surpass $9,000 for both metal tiers.
While CSRs effectively shield people with very low incomes from these costs, the protection diminishes significantly for households above 200 percent of the federal poverty level and is eliminated above 250 percent of FPL. These enrollees can opt for plans with lower deductibles, but only by accepting substantial premium increases. Moreover, even plans that appear more generous by reducing or eliminating their overall deductible often incorporate separate prescription drug deductibles. Ultimately, affordable marketplace coverage proves to be particularly challenging for those households with incomes above 250 percent of FPL.”
In 2017 the KFF (formerly the Henry J. Kaiser Family Foundation) had similar reports 8 years before the Commonwealth Foundation study was conducted. They revealed that premiums were preventing low-income patients from obtaining and maintaining coverage, has led to even more financial struggles when trying to receive quality and regularly accessible healthcare, and has made it difficult for patients to maintain healthy and fulfilling lives. The KFF reported,
“…premiums serve as a barrier to obtaining and maintaining coverage for low-income individuals, particularly for those with the most limited incomes. It also shows that even relatively small levels of cost sharing of $1 to $5 are associated with reduced utilization of services, including vaccines and preventive and primary care, and negative health outcomes, such as increased rates of uncontrolled hypertension and reduced treatment for children with asthma. Further, the research suggests that state budget savings from premiums and cost sharing in Medicaid and CHIP are limited and offset by administrative expenses, increased disenrollment from coverage and increased use of more expensive services, such as emergency room care. Research also finds premiums and cost sharing can put pressures on safety net providers, with increases in uninsured patients in hospital emergency rooms and community health centers. Specific effects on individuals, providers, and state costs depend on how premiums and cost sharing are structured and implemented.”
Even though it is constantly explained that the Metal Level tiers do not reflect the quality of health insurance it does indirectly reflect the quality of hospitals and care a patient can afford. These tiers were meant to help people pay lower premiums if they stuck to providers in the lower tiers, however within the capitalist United States prices often indicate the quality of services, this includes hospitals. Robert Field, a health policy professor at Drexel University back in 2015 explained,
“You get what you pay for under a tier system. If you want to go to a more expensive hospital then you pay more — higher co-pays and deductibles. And if you want to go with the cheaper ones … then it’s less out-of-pocket costs to you.”
Metal Level tiers are a deceptive, flawed, and broken addition to the United States’ already floundering healthcare system. It is a shame we currently live in a country where even the basic necessity and right of medical care is put behind a paywall and is now commodified. While the majority of the world has already improved their healthcare systems and switched to universal healthcare we have maintained a system which preys on and neglects the most marginalized members of our society all in the name of profit.
by Samuel Gomes Rodrigues Jr.
Sources
(https://www.kff.org/medicaid/how-do-premiums-and-cost-sharing-affect-low-income-people-in-medicaid/)
(https://whyy.org/articles/evaluating-advantages-disadvantages-of-tiered-health-plans/)
