Costs associated with health care are a major stressor for most Americans, whether they are insured or not. Traditional health insurance plans typically come with high out-of-pocket costs, such as deductibles, copays and coinsurance, that leave many Americans feeling like they don't have any real coverage if they get sick or need basic medical care.
In Texas, one of the fastest growing job markets in the country, people are finding good jobs with health benefits, yet employer-based health insurance does not guarantee access to affordable medical care, emergency services, or prescriptions. In fact, anyone who has, say, a $5,000 deductible, will pay the full amount for every doctor visit or inpatient and outpatient care received until their deductible is met. The only exception is preventive care, which includes yearly check-ups and age/gender appropriate health screenings covered 100% by the plan. However, follow-up care required during or after a preventive visit will be subject to that deductible.
As a result, many Texans just don't go to the doctor at all and are in turn deferring needed care, despite having health insurance. Importantly, this phenomenon extends to preventive care as well, and can give small problems the possibility of turning into bigger health problems requiring more costly, intensive treatment. We've reached a tipping point where the high out-of-pocket costs for health insurance are creating both a health and financial crisis for working Texans.
Recommended For You
To understand this impact, we launched a survey to learn more about how Texans are managing their health and the high cost of today's health plans. The findings are startling. We found that in the past year, a staggering 40+% of Texas residents with employer-based health insurance postponed seeking medical treatment because of financial worries due to high deductibles and out-of-pocket costs. During the same period, nearly 30% skipped a preventive health service, such as a yearly check-up or routine medical test. An astonishing 57% have cut corners on their health in one way or another due to cost. This includes not seeking care, skipping a recommended test or treatment and not picking up medications. The fact that more than half of respondents couldn't anticipate their out-of-pocket costs when seeking care only compounds the situation.
Sadly, some of the sickest people covered by health insurance can pay the heaviest price. We learned that two-thirds of insured Texans with chronic conditions have deferred care in the past year.
Affordability is the biggest issue leading to delayed or avoided care and that impacts Texans' financial health, as well. With 40% incurring medical debt and two-thirds using "creative" financial solutions to get needed care, most working Texans are experiencing great financial strain just to take care of their health. This includes measures like using credit cards, borrowing money from family or friends, dipping into long-term savings and rationing medications. One in five Texans simply cannot afford out-of-pocket costs period, even though they have employer-based health insurance.
Another study conducted by the Kaiser Family Foundation suggests 61% of Americans with employer-sponsored health insurance have some form of existing medical debt. All of these facts point to our nation's medical debt crisis and the $88 billion worth of medical bills currently in collections, according to the Consumer Financial Protection Bureau. This begs the question: Are we getting value and the right care for the money we pay for health insurance?
The answer is no. Not even close.
Health insurance should not be a barrier to health care. The status quo of today's health plans is leading to poor health outcomes, significant medical debt, and ultimately higher costs for employers and employees alike. This is because needed preventative care gets deferred and ends up costing more when it needs to occur in a higher acuity setting like a hospital or ER later.
It's time for a change to a model that removes these significant financial burdens and empowers people to get the right care, at the right time and in the right setting. Health insurance companies need to step up to this challenge – it's as simple as that.
The pandemic elevated the need to heal a broken health care system and it is possible to move the needle with better, more effective health insurance. Employers should be able to keep their employees healthy and productive through health insurance that enables affordable access to needed care. This holistic approach should be the baseline for all Americans with employer-sponsored health plans; one that will result in better health outcomes and sustainable cost savings for both employers and employees.
Curative's CEO and co-founder Fred Turner is a native of Great Britain and a resident of Austin.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
