Nearly 6 in 10 Americans report problems with their health coverage

Nearly 6 in 10 Americans report experiencing at least one problem with their health insurance in the past year, ranging from denied claims to difficulties finding an in-network doctor.

That’s according to a new poll out this morning from KFF, a nonprofit that conducts health policy research.

The issues appear pervasive for both Americans with private plans and those with Medicare and Medicaid coverage. And they’re most commonly reported among people with greater health care needs, such as those who rate their health as “fair” or “poor” and those who receive mental health treatment.

The big picture: The Affordable Care Act helped drive down the nation’s uninsured rate, and it’s now at a record low in part due to pandemic-era policies, some of which are expiring. Now, the question is whether that insurance coverage is working well for the people it covers.

Lawmakers on Capitol Hill have tried to fix some of these issues. Most people with insurance say they’d support requiring insurers to maintain updated provider directors and simple explanations of coverage decisions — which are all policies Congress has passed, though perhaps have not yet been fully implemented.

  • “The stakes are high,” said Kaye Pestaina, a vice president at KFF. “I think folks tend to think of it as just kind of a small inconvenience or an annoyance, but it can be particularly acute for those who need access to health care the most. Those day-to-day problems can really have financial and health consequences.”
The details

Coverage and access issues have been well documented by news outlets, such as a long-running KFF Health News series documenting exorbitant and baffling medical bills. In conversations with The Health 202, several experts said the new KFF poll gives weight to these anecdotal reports amassed throughout the years.

By the numbers:

  • About 26 percent said that a doctor covered by their insurance didn’t have any available appointments. One-third of Medicaid enrollees reported having such an issue.
  • Roughly 18 percent of those surveyed indicated their insurance didn’t pay for care they thought was covered. That complaint was more common among those with employer-sponsored health insurance and Obamacare plans.
  • Nearly 3 in 4 insured adults who have received mental health treatment in the past year report experiencing a problem with their insurance.

One thing that stuck out to us: People reported frustrations with their health insurance no matter if they get coverage through their employer, a marketplace plan or a public payer. The prevalence of different issues did vary by insurance type, however.

“Historically, employer sponsored insurance has been seen as the gold standard for the most robust coverage, and that public programs have had a little less stellar of a reputation,” said Sabrina Corlette, a co-director at Georgetown University’s Center on Health Insurance Reforms. “But these data suggests that it doesn’t really matter what your source of insurance [coverage is]. There are problems that people are encountering everywhere.”

Eye on insurers

Despite reporting problems, most insured adults — roughly 81 percent — gave their insurance overall positive ratings.

Yet, people in poorer health tended to give their coverage lower marks. About 84 percent of those who describe their health status as at least “good” rate their insurance high, compared with 68 percent of people with “fair” or “poor” health.

Major trade groups point to people generally being pleased with their plan. They acknowledge more work needs to be done, while underscoring already launched efforts.

David Allen, a spokesperson for major insurer lobby AHIP, said health plans are “committed to improving access, affordability, and convenience for all Americans.” He pointed to a policy road map the group released last year, which include a host of recommendations — some of which are aimed at various sectors of the health industry — like advancing site-neutral payments among doctors and hospitals participating in Medicare and accelerating the availability of biosimilar drugs.

By |2023-06-15T14:05:17-04:00June 15th, 2023|insurance, News|

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