Americans can’t afford to get sick — and limited plans could make things worse

The federal government announced new rules that would allow states to apply for waivers so they could permit insurers to sell limited health insurance plans that offer bare-bones coverage through Affordable Care Act (ACA) marketplaces. This comes on the heels of rules released this year allowing insurers to sell short-term and association health plans on the individual market.

Some argue this makes sense and that consumers want more affordable insurance options. The problem is that these plans are cheap but, in exchange for low premiums, they cover very little and can leave consumers who need health care with huge unexpected medical bills that they cannot afford to pay.

{mosads}This moves us backward in a health care system that already puts people who get sick, especially those who get very sick, on shaky ground.

A survey by The Commonwealth Fund, in partnership with Harvard’s T.H. Chan School of Public Health and The New York Times, found that millions of very sick Americans, including many who have health insurance, are at risk of financial ruin. In fact, 91 percent of the people in the survey had health insurance, but 53 percent of them still reported serious financial troubles.

We learned from the survey that when people become seriously ill, their worries about looming health care bills often crowd out thoughts about how to best manage their care. An estimated 15 million people spend their life savings when they get sick, and 9 million can’t afford rent, food  or heat. We also learned that it’s not just the sick who are impacted — the financial stress of a serious illness takes a huge toll on family members and caregivers who step in to help.

This is a bleak example of American exceptionalism — no other wealthy nation fails people who are ill as spectacularly as we do. Unfortunately, the new rules are part of a larger trend of eroding private health insurance. People with serious illnesses could end up as vulnerable as they were before the Affordable Care Act banned insurers from denying coverage or services, or charging higher premiums to people who were sick or had been in the past.

Despite the fact that 81 percent of voters agree it should be illegal for insurance companies to deny coverage to people with a preexisting condition, the Department of Justice has refused to defend this and other ACA provisions in a pending court case in Texas filed by Republican governors and attorneys general from 20 states. If the plaintiffs are successful in eliminating preexisting condition protections at the national level, people such as those we surveyed will face ongoing struggles to find any health insurance, let alone affordable health insurance that covers their illnesses.

As a nation that spends more than 18 percent of its GDP on health care, we can meet the needs of our sick without bankrupting them.

We can begin by bolstering the quality of health insurance coverage so that its purchasers get products that truly protect them from the costs of illness. And, we can make out-of-pocket costs such as deductibles and copayments more affordable for everyone. Even our Medicare program needs strengthening because of its high deductibles and copays.

We also must address health care costs, which are the primary driver behind high premiums and out-of-pocket costs. We need urgent action to bring drug prices down to reasonable levels.  Keeping costs under control will prevent bills from going unpaid and make it easier for patients to get timely, coordinated preventive care; avoid costly emergency room visits and hospitalizations; and stay on treatments that can help them get better.

The sooner we begin to take these steps, the better — because our sick friends, family members, and neighbors deserve better from our health care system. We all do.

David Blumenthal, an academic physician and health care policy expert, is president of The Commonwealth Fund, a national philanthropy engaged in independent research on health and social policy issues. Follow him on Twitter @DavidBlumental.