As we noted in a post here at Diabetes Flashpoints last month, the Affordable Care Act (ACA), often referred to as “Obamacare,” has helped almost 19 million people sign up for health insurance on state and federal online insurance exchanges. Many people who are eligible for coverage, however — often with very low premiums or for free, due to federal subsidies and programs like Medicaid — did not sign up. According to a poll released in August, the uninsured rate dropped from 18% to 13.4% in less than a year as the law went into effect, but that still leaves around 42 million Americans without health insurance.
So in the stretch leading up to the ACA’s second open enrollment period, which begins November 15, there is a scramble among federal and some state officials to get more people signed up. There is, however, a major barrier to reducing the number of uninsured: Most of them have no idea they can sign up for coverage next month. According to a poll released last week by the Kaiser Family Foundation, only 11% of uninsured respondents were aware that the next open enrollment period begins in November. When asked if they knew when the period begins, 76% of uninsured respondents said they didn’t know or didn’t answer, while 13% mistakenly believed it began at some other time. As noted in a CNBC article on the poll, 53% of uninsured respondents didn’t even know that subsidies are available to help people with low and moderate incomes buy insurance. As these dismal numbers demonstrate, federal and state officials have their work cut out for them when it comes to letting the uninsured know about their options.
In the face of this stiff challenge, U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell is trying to enlist doctors in the recruitment effort. According to an article in The Hill, Burwell asked for doctors’ help in remarks last week to the American Academy of Family Physicians. She noted that the upcoming open enrollment period is only three months long — half as long as the first one — and that doctors have a stake in ensuring that their patients get preventive care, which most people who don’t have insurance go without. Burwell remarked that for too long, the U.S. health-care system has “underdelivered on affordability, access, and quality,” and that doctors should lead the way in advocating for a system that contains health-care costs while ensuring that everyone gets high-quality care.
Burwell’s remarks came just as a new survey was released, showing that Americans have worse access to health care than residents of several other industrialized countries. (The other countries in the survey were Canada, Australia, New Zealand, Britain, Germany, France, Switzerland, Norway, and Sweden.) According to an article at HealthDay, the survey — conducted in 2013 by the Commonwealth Fund, just before the ACA’s first open enrollment period — showed that about 50 million people were uninsured at that time. Americans were more than three times as likely as residents of the other countries to say that cost was a barrier to getting health care, with roughly 3 in 10 Americans saying this was the case, compared to around 1 in 10 foreign respondents. Even Americans with insurance tended to have much higher out-of-pocket costs than residents of the other countries, all of which have universal health insurance coverage. Overall health-care costs in the United States were also much higher — 50% to 200% higher, per person, than in the other countries. Lower-income Americans had to wait longer for doctor’s appointments, and to see a doctor during emergency-room visits, than lower-income residents of the other countries.
What’s your take on insurance and access to health care in the United States — does it matter that 42 million Americans are uninsured? Do you think, as many experts do, that insuring more Americans would lead to fewer expensive emergency-room visits and more preventive care, reducing overall health-care costs? Should doctors help their patients get and keep insurance coverage, or try to convince their patients to sign up for coverage? Since most uninsured people probably don’t have a regular doctor, who might be more effective at making sure they know their health-insurance options? Leave a comment below!