LIMA — The potential out-of-pocket costs for an employer health insurance plan were equivalent to 11% of Ohio’s median income in 2018, a new report from The Commonwealth Fund has found, following a nationwide trend in which employee contributions to their workplace health insurance plans have been rising faster than wages.
The Commonwealth Fund, a private health care policy research foundation, found that the average potential costs for premiums and deductibles for single and family employer health insurance plans in Ohio reached $7,509 in 2018, up from $3,648 in 2008.
The problem is most acute for those enrolled in family plans: Average annual premiums for a family plan in Ohio was $2,642 in 2008, compared to $5,016 in 2018. A single plan, by comparison, had average annual premiums of $1,632 in 2018, according to Commonwealth Fund estimates.
And, as the Commonwealth Fund report notes, family plans are not eligible for the Affordable Care Act market subsidies offered to singles whose employer insurance premiums equal about 10% of their income.
“This is concerning because it may put both coverage and health care out of reach for millions of people,” Sara Collins, vice president for health care coverage, access and tracking at The Commonwealth Fund and the study’s lead author, said in the report.
People with low to moderate incomes may forego coverage altogether, the report concluded, while others may avoid seeking care or ordering prescriptions because of high deductibles.
And those who are insured are dedicating a larger share of their take-home pay to health care.
“As we spend more on health care, you can’t spend that money on housing, education, a new car,” said Eric Seiber, professor of health services, management and policy at The Ohio State University in Columbus.
Seiber said premiums rise when overall health care spending increases, which he attributed in part to hospital consolidations and rising prices. But he noted that the shift by employers to high-deductible plans helps keep premiums down.
“As total health care spending goes up,” he said, “one of the ways to keep them from going up as quickly is to remove spending from premiums. We’re going to cover less. Premiums would be even higher if we didn’t raise deductibles.”
Those high-deductible plans can have consequences for low- to moderate-income families who need care but can’t afford the out-of-pocket expenses.
“We frequently treat patients who waited until they knew their illness or injury has progressed significantly before they consider seeking care and – when asked about it – we commonly hear ‘lack of access to healthcare’ as the reason cited for not coming in sooner,” said Alexander Bobrov, medical director of the Mercy Health-St. Rita’s Medical Center Emergency Department.
“Patients without health insurance who may sometimes be looking to appropriately get into a primary care provider or specialist may face a large out of pocket payment – or haven’t yet met a very large deductible – that they feel is unaffordable and will therefore either present to the ED to seek care or wait until their disease process is so bad that they have no choice but to seek care through the ED.”
While The Commonwealth Fund suggests several policy changes to make health insurance more affordable – such as extending market subsidies to those with family plans – the foundation stops short of endorsing any Democratic or Republican healthcare reform policies.
Seiber said the policy debate is unlikely to be resolved anytime soon but will probably involve experimentation at the state level, where it’s easier to form a political consensus.
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