How health insurance has become a barrier to health care 

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. 

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.