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Research Shows High Patient Costs & Less Access to Care

The High Cost of Healthcare: Patients Experience Greater Cost-Shifting and Reduced Coverage in Exchange Market 2014-2018

New research conducted for PFC by Avalere, a leading healthcare research firm, shows that patients are paying more for their healthcare coverage through higher premiums, deductibles, and cost sharing, while their insurance networks are becoming more narrow and restrictive. Patients are paying more for less access to care, doctors are being paid the same and insurance companies are making record profits. Read the summary fact sheet and full report.



Main Takeaways from the Report

  1. Healthcare insurance plans available in exchange markets have grown increasingly narrow, restricting patient access to care.
  1. Overall costs for insurance premiums, deductibles, and out-of-pocket costs are increasing faster in exchange markets.
  1. Insurers are increasing profit margins while doctor salaries remain consistent.
  1. Federal and state network adequacy rules are not protecting patients from paying more for less.



Key Stats

  • In 2017, 68% of healthcare plans in the exchange market offered restrictive networks, compared with 48% in 2014.
  • Average ACA exchange market premiums increased 28% from 2014 to 2017.
  • Plans covered between 34% – 66% fewer providers than other markets.
  • Almost 90% of enrollees in ACA exchange plans had deductibles above $1,300, the IRS definition of a high deductible plan.
  • Several top insurance companies saw profit margins in Q1 for 2018 that were the highest in a decade, and all six of the largest insurance companies paid their CEOs over $17 million in 2017.


Patients Are Increasingly Vulnerable to Surprise Bills

Federal requirements are not doing enough to protect patients. The ACA provides some level of out-of-network protections for patients. However, as health plans are increasingly offering limited or non-existent out-of-network coverage, patients are at higher risk of bearing greater costs and receiving balance bills for services their insurers aren’t covering.

Our PFC's model legislation provides states with a path to implementing a comprehensive, fair solution that takes patients out of the middle, ends surprise bills, closes surprise insurance gaps, increases transparency and ensures long term access to quality care. Some states, including New York and Connecticut, have already implemented similar solutions to protect patients.

As part of our report, we looked at local markets in a few states to get a close up look at increased patient costs. Below are links to more information for certain states: