There are an estimated 31 million Americans with private health insurance who can barely afford to use it. A recent report from the Commonwealth Fund dubs these people as "underinsured," because their deductibles and out-of-pocket costs are so high relative to their incomes.
Twenty-eight-year-old Diana Ionescu of Los Angeles is a typical underinsured. She has two part-time jobs, but she doesn't get health insurance through either one. Thanks to the Affordable Care Act, though, she was able to buy a cheap, subsidized plan through Health Net last year.
Ionescu would like to use her insurance, but she generally doesn't. Her plan has a $1,000 deductible, meaning she will have to pay $1,000 in medical bills before her coverage kicks in. So she skips doctor's visits.
"I do have some back pain that is probably from biking and backpacking and a previous moped accident that I haven't really gotten checked out, and I've been putting it off," Ionescu says, over lunch at L.A.'s Grand Central Market.
You get an estimate before you agree to any car repairs. You know what a dish costs before you order it off a menu.
But when it comes to health care, it's extremely difficult to find out in advance what a test or procedure will cost.
Why do we pay for health care differently from virtually every other service or product?
The reasons are many and varied; it all starts with our byzantine insurance-based health economy, in which we pay these mostly for-profit firms to provide us access to medical care. Meanwhile, the insurers are using complex actuarial analysis to set premiums, deductibles, co-pays and co-insurance. Hospitals have their own inscrutable methods for setting how much they will charge for various services and procedures. Then there are the secret haggling sessions between insurers and hospitals. And we've got the government-funded Medicare and Medicaid (Medi-Cal in California) programs.
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The colonoscopy is getting its 15 minutes of fame here on Impatient!
As I shared recently, KPCC - with our friends at KQED and clearhealthcosts.com - has re-launched PriceCheck. Through this project, we're crowdsourcing the costs of certain medical procedures. Right now, we're focusing on colonoscopies.
Screening colonoscopies are considered preventive care under the Affordable Care Act, and therefore should be fully covered by insurance. But as I explained last week, there are several reasons your colonoscopy might not come free of charge.
One reason: You might be on the hook for part of your colonoscopy if you don't meet the age requirements, according to Dr. Jeffrey Rice, founder and CEO of Healthcare Bluebook. The U.S. Preventive Services Task Force generally recommends screening colonoscopies for people age 50 and up.
Drink in this week's top consumer health stories: They're all about controversy, questions and curbing soda consumption among kids. Read on and then weigh in on any or all of these stories!
Impatient: Where a state bill mandating vaccines stands
The bill that would require all school-aged kids to be vaccinated passed the state Senate earlier this month. It's slated to move on to the Assembly Health Committee in coming weeks.
On Take Two this week, I offered an update on the bill and the controversy swirling around it. And on Morning Edition, KPCC senior health reporter Elizabeth Aguilera provided this nuanced explanation for why the California Chiropractic Association is opposed to the legislation.
Second opinions are often sought, but their value isn't clear
Common knowledge says that if a doctor diagnoses you with a serious illness or recommends confusing treatment options, you should get a second opinion.
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As we head into Memorial Day weekend, here are the top stories you should read about your money and your health. Plus, one important story you shouldn't miss.
Covered California votes to cap specialty drug costs for some
Covered California has become the first state health exchange in the nation to impose a cap on out-of-pocket costs for specialty drugs. The action is intended to make expensive, life-saving drugs more affordable for people who buy insurance through the state exchange.
Beginning in 2016, people who purchase most Silver, Gold and Platinum plans through Covered California will pay up to $250 per specialty drug prescription per month. Consumers enrolled in Bronze plans, which have lower premiums, will pay up to $500 per prescription per month, after meeting a $500 pharmacy deductible.