QuickTake: Less Than Half of Insured Adults Who Reported an Unmet Need for Health Care Because of Cost Knew How Much the Care Would Cost
Laura Skopec and Sharon K. Long
February 26, 2016
The Affordable Care Act contains several provisions designed to address the affordability of health insurance and health care services. Between September 2013 and March 2015, during implementation of the Affordable Care Act, the share of nonelderly adults reporting an unmet need for care because of cost fell 2.7 percentage points, but nearly one-third still reported difficulty affording care (Shartzer, Anderson, and Long 2015). However, relatively little is known about whether respondents reporting unmet needs because of cost were aware of the specific cost for the service. Accordingly, the September 2014 wave of the Health Reform Monitoring Survey asked respondents who reported an unmet need for care because of cost to choose among the following options to describe why they decided they couldn’t afford care: I knew how much the care would cost and knew that I could not afford it; I wasn't sure how much the care would cost but was afraid that I could not afford it; it didn't matter how much the care would cost since I knew that I could not afford it; and something else that doesn’t fit in the above responses.
In September 2014, 29.3 percent of adults who were insured for all of the past 12 months reported an unmet need for care because of cost during the past 12 months (data not shown). Among the full-year insured respondents reporting an unmet need because of cost, only 45.7 percent knew the cost of the care. The remainder did not know the actual cost of care but went without needed care either because they worried that they couldn’t afford the care (20.3 percent) or because they knew they couldn’t afford the care (22.9 percent; figure 1), raising questions about gaps in needed care that may be because of a lack of information on costs.
Nonelderly adults with full-year insurance and family income at or below 138 percent of the federal poverty level who had an unmet need for care because of cost were less likely to report that they knew the cost of the care than adults with higher family incomes (37.4 percent and 48.8 percent, respectively) and were more likely to report that the cost of the care didn’t matter because they knew they couldn’t afford care (38.1 percent and 17.2 percent, respectively; figure 2). In contrast, there were not significant differences in awareness of cost by health status: 45.1 percent of full-year insured adults in excellent or very good health, and 45.3 percent of those in fair or poor health, who had an unmet need for care because of cost were aware of the cost of the service (data not shown).
Respondent awareness of cost also varied by service: those who reported unmet needs for dental care or prescription drugs were more likely to report that they knew the cost of the care and couldn’t afford it than those who reported unmet needs for doctor or specialist care (46.0 percent for dental care, 42.7 percent for prescription drugs, and 36.4 percent for doctor or specialist care; data not shown). This may reflect the greater price transparency at the point of service for dental care and prescription drugs as well as greater information on what patients’ share of that cost will be for those services.
Research has shown that many Americans struggle to understand their health insurance coverage, particularly the financial aspects of coverage, such as co-payments and coinsurance, and that health insurance literacy is lower among low-income adults (Institute of Medicine 2014; Long, Shartzer, and Politi 2014; Long and Goin 2014; Kenney, Karpman, and Long 2013). In addition, health care costs are often not transparent both because cost is often only revealed after care has been received and because it may not be clear initially which services may be needed to respond to a symptom. Gaps in health insurance literacy combined with poor price transparency may be driving some insured adults to forgo needed care because of concerns about cost, even if they do not know the specific cost of the service. This suggests that reducing unmet needs will likely require a combination of consumer education and price transparency as well as cost-lowering strategies.
Institute of Medicine. 2014. Health Literacy and Numeracy: Workshop Summary. Washington, DC: National Academies Press.
Kenney, Genevieve M., Michael Karpman, and Sharon K. Long. 2013. “Uninsured Adults Eligible for Medicaid and Health Insurance Literacy.” Washington, DC: Urban Institute.
Long, Sharon K., and Dana Goin. 2014. “Large Racial and Ethnic Differences in Health Insurance Literacy Signal Need for Targeted Education and Outreach.” Washington, DC: Urban Institute.
Long, Sharon K., Adele Shartzer, and Mary Politi. 2014. “Low Levels of Self-Reported Literacy and Numeracy Create Barriers to Obtaining and Using Health Insurance Coverage.” Washington, DC: Urban Institute.
Shartzer, Adele, Nathaniel Anderson, and Sharon K. Long. 2015. “Access to Care and Affordability Have Improved Following Affordable Care Act Implementation, Problems Remain.” Health Affairs 35 (1): 161–68.
About the Series
For more information on the HRMS and for other QuickTakes in this series, visit www.urban.org/hrms.
About the Authors
Laura Skopec is a research associate and Sharon K. Long is a senior fellow with the Urban Institute's Health Policy Center.