Thosewith chronic health conditions have also been hit hard by costs,with the price of care erecting a barrier to necessary access.(Photo: Shutterstock)

More coverage doesn't mean more care, since the cost of care isstill beyond the reach of many despite more people having insurance coverage since thepassage of the Affordable Care Act.

That's among the findings of a new report published in JAMA Internal Medicine, which also points outthat the uninsured "felt the brunt of overall rising carecosts."

Related: States coming up short on health careaffordability

Dr. Laura Hawks, the study's lead author and a research fellowat Massachusetts-based health system Cambridge HealthAlliance, told Modern Healthcare, "Thequality of private health insurance is getting worse, and the costof healthcare is rising significantly. We know that private healthinsurance plans increasingly rely on high premiums, high-deductiblehealth plans, high copays and other forms of cost-sharing—thesesuggest that insurance generally is not doing what it is supposedto do—ensure people have access to health care when they needit."

Individuals in the $50,000 to $75,000 annual incomebracket were hardest hit by the costs, the report says, with thepercentage of those who couldn't afford the cost of going to thedoctor increasing from 6.9 percent in 1998 to 12.4 percent in 2017.Groups making the lowest income reported the least change in theirability to afford a doctor's care.

Those with chronic health conditions have also been hithard by costs, with the price of care erecting a barrier tonecessary access. Nearly 20 percent of individuals with any chroniccondition in 2017 said they couldn't afford to pay for a doctor'scare and thus did not get it.

More people got preventive care like flu shots and cholesterolchecks, but for other preventive services—such as mammograms—that'snot the case, with the 12.5 of women not receiving mammographyscreenings in 1998 rising to 19 percent in 2017. Study authorswrote, "Persons with conditions such as diabetes, hypertension,cardiovascular disease and poor health status risk substantialharms if they forgo physician care."

All this is despite the increase in people covered by healthinsurance. Since the ACA's inception in 2010, the uninsured ratefell from more than 46 million to just below 27 million in 2016.And while a Commonwealth Fund report in 2015 said that therise in coverage brought a rise in access—and a decline from 43percent in 2012 among those not getting health care because of costto 36 percent in 2014—that doesn't mean the problem has goneaway.

Instead, the JAMA study says that the 33 percent of uninsuredpeople who said they couldn't afford to go to a doctor in 1998 hasrisen to 39 percent in 2017, and even among the insured it rosefrom 7 percent in 1998 to 11 in 2017.

People with insurance coverage have seen a shift in insurancecosts onto them over the past 20 years, According to an analysisfrom Kaiser Family Foundation, those with employer-sponsored healthinsurance pay 67 percent more than they did a decade ago due toincreasing costs and premiums.

The study's conclusion is bleak: "Despite coverage gains since1998, most measures of unmet need for physician services have shownno improvement, and financial access to physician services hasdecreased."

Says Hawks, "Health coverage needs to be both universal,covering everyone, and comprehensive, paying in full for allmedically necessary care. Universal coverage that includessignificant cost-sharing—high copays and deductibles—will improvebut not minimize the high levels of unmet health needs wedocumented in our study."

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