Within a few months, 37-year-old Kimberly Cooley went from sprinting up the stairs to staggering after several steps. Unbeknownst to her, she was experiencing a series of symptoms related to diabetes autoimmune hepatitisa rare and chronic inflammation of the liver.
She was diagnosed, placed at the top of the liver transplant list, and quickly realized that she could not handle the financial consequences of such an operation alone. A private citizen by nature, Cooley took the extraordinary step of publicizing her condition – a move she understood well as a marketing consultant.
In a few days, her loved ones raised more than $17,000 for her liver transplant.
“I had the support of friends and family,” said Cooley, 42, who lives in rural Duck Hill, Mississippi. “So it wasn't as bad as it could have been.” Cooley is doing well. But her finances are a different story.
She is more than $4,000 in debt to AccessOne, a private equity-backed medical credit card company. Because transplant patients require ongoing medication and care, she expects that debt to roughly double next year.
“I'm starting to call it 'transplant life,'” Cooley said. “Things will come up, and that's just part of it.”
As the new year and the presidential election approach, Americans face a worsening crisis: healthcare affordability. More Americans than ever about 92%now have health insurance – and at the same time face enormous bills.
Over the past ten years, insurers and employers have led to individuals and families sharing more costs. Now, under pressure from medical costs and inflation, more than 100 million Americans have medical debt and about the same percentage report that they avoid a prescription as a result.
Sara Collins, a health policy scholar and vice president at the Commonwealth Fund, said, “These are the trends we've seen,” referring to “the growth of health care costs, household incomes that haven't kept pace with those costs, and employers 'use greater cost sharing'.
Cooley's story represents the intersecting problems plaguing the healthcare system as high prices and the drive to pass those costs on to patients collide.
“These trends are all still here, they haven't changed, and unless they are addressed,” the problems will persist, Collins added.
The Biden administration has sought to make this fight a centerpiece of the coming campaign. His administration has targeted medical credit card companies, such as AccessOne; directed Medicare to negotiate prescription drug prices For the first time; and writes rules to prevent medical debt from appearing on credit reports.
The Biden administration also continued the rollout of the No Surprises Act, originally signed by Donald Trump, which prohibits doctors and hospitals from imposing a “balance bill” on consumers if they cannot agree with insurers on a fair price.
Trump, the leading Republican presidential candidate, also has an extensive record on health care. He led a failed repeal of the Affordable Care Act (ACA), better known as Obamacare, which would likely have left tens of millions of Americans uninsured and effectively worsened health care rationing by income. He infamously tilted the balance of the Supreme Court to the right, leading to the reversal of the constitutional right to abortion and strict abortion restrictions in much of conservative Southern states.
Now campaigning for a second term, Trump has said:Obamacare sucks', and promised to try to 'replace' it. He did not provide details on such a policy.
Neither candidate has decisively tackled the biggest problem in American health care: its cost.
The US healthcare system sucks in a whopping 16% of gross domestic product (GDP). That is – by a long shot – more than any other rich, developed country. According to the Organization for Economic Co-operation and Development (OECD), the closest are France and Germany, each spending around 12% of GDP on healthcare.
Over the past decade, insurers and employers have tried to achieve more of this growing costs on patients, which in turn has exposed Obamacare's unfinished work.
The focus of the ACA was to get more people insured, and was very effective at doing so through both Medicaid and marketplaces for individuals to get health insurance, and that's where Cooley got her health plan.
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It did not focus on employer-based health care coverage, as these were generally comprehensive and heavily subsidized by corporate tax breaks. Since the ACA, because health insurers have to provide more comprehensive coverage, they have also pushed costs onto enrollees.
More than half of Americans (51%) now have trouble dealing with their own insurance costs, according to a US newspaper Commonwealth Foundation research. High deductible health insurance offers a glaring example of why.
Laurie, a 62-year-old resident of the Atlanta, Georgia metropolitan area, must spend $7,450 each year before her insurance kicks in. As a result, she buys her ulcerative colitis medications in Canada at a discount of about 90%. the US price – which is typically around $1,800 for a 90-day supply.
“The insurance companies are now giving this to everyone with the maximum deductible and deductible,” said Laurie, who asked that her last name not be used because she was concerned about the legality of buying drugs internationally. “Besides, I pay $120 a month for the privilege of having this plan.”
In another case, a mother of six in Ohio said she faced a $6,000 deductible for an employer plan that “barely pays anything.” She now avoids taking her children to the doctor for a minor cold because she has to pay a $95 co-pay for each doctor visit.
“We feel like we are being forced to take out this insurance for fear that one of us will have an accident or illness and have no insurance at all to cover it,” she said, adding that her husband's wages as a welder would be much higher. “sufficient” if the insurance costs were not so high.
A slew of studies show how high-deductible plans can make a family's life precarious. One study found that such plans “substantial and problematic“Reduce how often low-income diabetics seek care. Another thought so children who participated in their parents' high-deductible plans scored worse on seven out of ten health metrics. A third found that people with high deductible health insurance are more likely to have medical debt and subsequently struggle to afford food and housing.
Yet an alarmingly large number of health insurance policies, especially on the marketplaces, contain these provisions. “Obamacare” plans, like Laurie's, may have deductibles range up to $9,050 per year.
Chronically ill people also face special challenges. Cooley has no deductible and out-of-pocket expenses are capped at $3,150 per year. A healthy person may never reach that limit. But Cooley will achieve it every year.
Moreover, Laurie says, she still has to deal with dental bills, for which health insurance is useless.
“That insurance doesn't cover your hearing, your teeth and your eyes,” said Laurie, who said a dentist told her that replacing a single problematic crown would cost her $5,000. “I thought, they're not part of my body?”
Hundreds of millions of American adults will probably nod in agreement with Laurie's conclusion: “Don't get sick. It is too expensive.”