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People increasingly going without health care, even when they have health insurance

16541044-mmmainWhen Jay Korobow walks into a pharmacy that offers a self-administering blood pressure cuff, he takes a moment to get a reading.

If his blood pressure reading is high, the Browns Mills man said he will go online to read up about foods he should eat and items he should avoid to get that number down.

“I self-treat myself,” he says.

But it’s not because Korobow, who is “near 60” lacks health insurance coverage.

Korobow is part of a growing swath of the American public that puts off seeking care from a medical professional because, even with health coverage, the cost of care is simply too expensive, according to two recent polls and a statement from the American Academy of Pediatrics.

“If I have a cough,” he said, “I hope for the best, so to speak… You don’t want to go to the ER, because that could cost hundreds.”

Recent surveys provide evidence that some Americans are taking Korobow’s approach to health care. They are skipping health care in spite of federal and state efforts, particularly through the Affordable Care Act, that have lowered the numbers of the uninsured.

In a survey taken in the fall, The Commonwealth Fund, a private, independent health care research organization, found that about 40 percent of adults nationwide who had high-deductible private insurance plans reported delaying care because of the cost.

In another, the Gallup Poll, which annually asks about health care cost and use every November, reported that the percentage of Americans who had insurance and chose not to go to a health care professional for a routine visit or a need because of cost hit an all-time high of 34 percent.

“Last year, many hoped that the opening of the government health care exchanges and the resulting increase in the number of Americans with health insurance would enable more people to seek medical treatment,” Gallup said. “But, despite a drop in the uninsured rate, a slightly higher percentage of Americans than in previous years report having put off medical treatment, suggesting that the Affordable Care Act has not immediately affected this measure.”

The Gallup survey showed that Obamacare has begun to help its target group as a whole. The percentage of middle-to-lower income Americans who said they skipped getting health care because of cost dropped, it said. The federal health care law targeted this population because it was the largest group among the uninsured – too wealthy to qualify for Medicaid, too poor to afford coverage.

However, among households making $30,000-$75,000 a year, 38 percent said cost forced them to forgo health care, Gallup said, up from 33 percent in 2013.

In even wealthier households, the least likely to have Obamacare coverage, the increase was more pronounced. In households making more than $75,000 a year, it said, 28 percent reported skipping professional health care services due to cost. That figure is up 65 percent over 2013, according to the survey.

The problem is easy to identify but difficult to solve. Health care is extremely expensive in the U.S., and to keep from busting their budgets, companies that provide coverage to their employees and families increasingly are turning to plans that keep monthly premiums lower by increasing deductibles and charging more for out-of-pocket costs, said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute.

“More and more of [the cost] is being put on the employee, and because of that, they’re reluctant to get the care they need because they’re concerned about the cost,” she said.

Rick Pula of Piscataway is another of the insured who said he considers cost before seeking professional help.

Pula, 61, early this year fell on ice, he said, injuring his back, which already was sore from disc problems. The pain re-emerged in recent weeks, but he is trying to wait it out as he has done in the past, he said.

“I am procrastinating going to the doctor because of experience with back pain and that it will usually subside,” Pula said.

He said his share of the doctor’s bill, plus the cost of a scan such as an x-ray or MRI and rehabilitation therapy makes the pain something he’ll have to accept.

After paying $500 for a walking boot he had gotten for a recent foot fracture, Pula was reluctant to see how high health care bills would be for his back.

“Unbelievable,” he said. “How do they justify it?”

It’s justifiable because health care is costly, but many factors go into the price of its goods and services, said Kerry McKean Kelly, vice president of communications and member services for the New Jersey Hospital Association. Advances in pharmaceuticals and technology are expensive, and high use of health care, especially in the Northeast, requires numerous facilities and staff, she said.

Hospitals are doing their part to rein in costs by giving up an estimated $4.5 billion in Medicare reimbursements over Obamacare’s first 10 years, she added.

More sacrifices will be necessary, said Wardell Sanders, president of the New Jersey Association of Health Plans.

“There needs to be much greater focus on addressing the underlying health care cost drivers, such as the price of services, to ensure affordable health care for consumers,” he said. “This is especially true in New Jersey, which has some of the highest health care costs in the nation.”

One place to attack is what Schwimmer calls “actionable transparency,” or simply letting consumers see the actual cost of health care goods and services and giving them options.

When insured patients go to physicians’ offices, pharmacies and hospitals, they have no access to a menu of price information. Without knowing the full cost, consumers are “paralyzed,” she said, so they don’t take care of their health needs. As time goes on, those needs become more critical, leading to higher costs and worse outcomes, Schwimmer said.

Assemblyman Craig J. Coughlin in October chaired a hearing over health care costs. The legislature is looking into a number of bills that could address the issue, he said, including measures that would give more price information to consumers or create an arbitration system to resolve billing disputes between insurance companies and health care providers.

Efforts to get costs under control have bipartisan support, he said, noting that publicity over astronomical bills for seemingly routine procedures provoke outrage.

“Those things shock the conscience,” he said.

The national pediatrics organization this year issued a policy statement suggesting that the federal government may want to limit high-deductible health plans to adults because its members see families withholding important primary care for their children. Because their bodies are young and in development, children are high users of health care, and high-deductible policies may drive some families to skip visits or care they deem non-essential, it said.

Whether the payment is for insurance or to the provider, it’s still too high for people like Korobow. As a part-time IT consultant with sporadic free-lance jobs, Korobow, who was covered through his wife’s insurance policy, says he might make around $20,000-$30,000 a year.

“I can’t afford the full price of medical insurance,” he said, “or go to the emergency room at $500 a shot.”

By: Tim Darragh Source

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