Health Insurance in the U.S.: Coverage Like a Hospital Gown


“Here, put this on and then the doctor will be with you shortly.”

Those are not generally welcome words. It means putting on the dreaded hospital gown.

Most people know what it is like to wear a hospital gown – it is a humbling experience. You feel barely covered. I know I always am walking around in fear of the “inadvertent disclosure.”

According to a recent Gallup survey, the uninsured rate in the U.S. has reached an all-time low at only 11 percent, the lowest since 2008, when it dipped to 14.6 percent just prior to the recession. It seems people are getting covered more than ever before. Moreover, it also appears that, according to a paper published by the National Bureau of Economic Research, the poorest among us are seeing a reduced medical debt. The Medicaid expansions under the Affordable Care Act are helping low-income individuals improve their ability to pay their medical expenses. So more people are becoming insured and the poorest are getting some medical debt relief. That all sounds great.

But, like a hospital gown, it seems that the coverage is not so complete. A new poll by National Public Radio, The Robert Wood Johnson Foundation and Harvard’s T.H. Chan School of Public Health shows that many with coverage continue to struggle with paying their medical bills. The survey found that a quarter of the people said that medical bills have caused serious financial problems within the last two years, the biggest culprit being the high-deductible plan.

The high-deductible plan is the hospital gown of insurance — it’s too often covering too little and prone to gaps. Out-of-pocket medical costs for most consumers are booming. And, according to a Kaiser Family Foundation study, these costs are growing much faster than wages. The Commonwealth Fund found that 43 percent of privately insured adults said their deductibles were difficult or impossible to afford. Gaps are opening in the gown of coverage.

Not only are consumers being exposed – but so too are the hospitals and doctors, who for the first time are having to look increasingly at the consumer for much of the payment for care. Payments from patients to hospitals are expected to increase at an annual compound growth rate of 10 percent. Out-of-pocket costs for insured patients accounts for a growing percentage of providers’ accounts receivables. But if patients can’t pay their bills, where will the money come from? If patients don’t believe they can afford their deductibles and co-insurance, will they even seek care unless absolutely necessary?

So while we can generally be pleased that more people are covered, the message is that we are not done. There are too many holes remaining, and until they are closed, we should all be embarrassed.

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