Five years after the passage of the Patient Protection and Affordable Care Act, an estimated 35 million Americans remain uninsured, and despite increased access to coverage and penalties for going uninsured, many still prefer cash, bartering and charity care, according to The Wall Street Journal.
Here are five things to know about the millions of health insurance holdouts.
1. Based on estimates from the Congressional Budget Office, 45 percent of the 35 million uninsured Americans are uninsured by choice. In fact, only 20 percent of uninsured adults would buy health insurance if their finances improved, choosing instead to pay off debts, put money in savings or pay for home or car repairs, according to a Robert Wood Johnson Foundation poll cited in the report.
2. The ranks of uninsured are diverse. In addition to those who have opted out of health insurance, the pool of uninsured Americans includes unauthorized immigrants who are excluded from the law, unenrolled Medicaid-eligible people and those who live in non-expansion states but are otherwise Medicaid-eligible, according to WSJ. There is also no one type of American holding out on getting insurance. The group covers the spectrum on income, health status and geographic location, according to the report.
3. Those holding out know what they are doing. Many who have not bought health insurance are doing so because they feel it is less expensive to pay their own way and they have the research to back it up: 43 percent of uninsured adults have looked at health plans in the past 12 months, according to the RWJF poll. And, despite the rising penalty for remaining uninsured, which is set to increase from $325 to $695 next year, only 26 percent say the fine would make them more likely to get insured.
4. Instead of buying insurance, the holdouts are cobbling together care and "self-insuring." Many uninsured Americans are confident they can manage costs of physician visits, prescriptions, check-ups, emergency care and preventive tests, according to the RWJF poll, and many have already had to manage paying for these services. According to the poll, 56 percent of uninsured adults are confident they can self-manage the costs of physician visits, and 32 percent already have. About 38 percent pay for care out-of-pocket as needed, while 28 percent use free or low cost clinics and 26 percent go without care. The cost for uninsured patients at many physicians' offices is "surprisingly reasonable," according to the report, and if it isn't, 9 percent of people are willing to haggle costs down.
5. Some costs are passed on. Inevitably, some of the costs of caring for uninsured patients are passed on to the healthcare system as a whole, and supported by taxes and those who do pay for insurance, according to the report. This puts many providers at a crossroads, between cutting back on charity care programs and beefing them up. The industry is seeing a little bit of both strategies, according to the report.
More articles on finance:
Which vendors are providers turning to for alternative payment model support?
King v. Burwell decision would cause most Americans to switch healthcare providers
41% of silver plans in 'x-small' or 'small' networks and 8 other findings