Predictable, Manageable, Out-of-Pocket Costs & Limited Cost Shifting

Health care costs have continued to rise, resulting in consumers having to pay significantly more out-of-pocket for their health care. Consumers have seen these out-of-pocket costs increase in the form of premiums, deductibles and cost-sharing for most health care services. These varying out-of-pocket costs, combined with a lack of information about costs and what contributes to them, create a situation of unpredictable and unmanageable costs, which negatively impact both consumers ability to access needed care and their health care outcomes.

Rising costs across all health care sectors are driving cost shifting. The drivers of the persistent rise in health care costs are varied and interconnected and include factors related to in-patient and out-patient costs.

A 2014 Gallup poll showed that 1 in 3 Americans have put off some kind of medical treatment for themselves or members of their families due to cost and that more put off treatment for serious conditions than non-serious conditions. The strategy of shifting costs to patients and beneficiaries is not sustainable and must be limited.

A recent study by the Commonwealth Fund found that as many as thirty-one million people with health care coverage in the United States were underinsured in 2014. The study also found that:

  • Half (51%) of those who were underinsured had problems paying medical bills or were paying off medical debt over time.
  • In 2014, 14 million people had deductibles that were 5 percent or more of their income, while only 4 million had deductibles that high in 2003.
  • 44 percent of respondents either didn’t go to the doctor when they were sick; did not fill a prescription; skipped a physician-recommended medical test or follow-up visit; or didn’t see a specialist when their doctor told them to do so.