Nearly a quarter of working-age adults have health insurance that leaves them underinsured, according to recent estimates. While having some coverage might seem better than none at all, experts say the potential risks are remarkably similar.
"We always see people who avoid the hospital because of costs," said Dr. Anahita Dua, vascular surgeon, associate professor of surgery, and founder of the medical community coalition Healthcare for Action.
Dua says health care providers are seeing more patients skip or delay care out of fear they won't be able to afford it, even with insurance coverage.
"Patients are concerned that if they come in with their wrists sprained, and then they tell the doctor, 'Well, I sprained my wrist by falling down the stairs,' the doctor might say, 'Well, did you hit your head? We need a CT scan of your head,' which we do," Dua explained.
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The numbers paint a stark picture of America's health care coverage crisis.
In findings from the Commonwealth Fund, roughly 9% of working-age adults are uninsured, but another 23% are underinsured — meaning the coverage they pay for doesn't provide affordable access to care.
"What we're really saying is that maybe their deductible is too high. They can't get to that high number before their insurance kicks in," Dua said. "Or their insurance doesn't cover the things that they need. It'll cover one doctor's visit, but not four doctors' visits."
As president of Accessia Health, Tiara Green says she sees this issue firsthand. The nonprofit provides support for people living with rare or chronic health conditions.
"They need access to specialty medications and treatments and specialty providers," Green said. "They become underinsured or considered underinsured when they don't have access to those things."
Green says Accessia Health works to close the gap so patients can access the care they need.
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Dua says free clinics can also help bridge coverage gaps. But most importantly, she urges patients to never delay care.
"The most important thing is your life. Everything can be worked out. Hospitals do eat major costs, so do not delay," Dua said.
The situation may worsen with the expiration of enhanced tax credits for those who purchased plans on the ACA marketplace. Experts fear more new cases of people going uninsured and underinsured.
"It could lead to a number of individuals choosing high-deductible plans that may not necessarily cover their costs and lead to higher out-of-pocket costs," Green said.
