With all of the attention on the U.S. Supreme Court and issues of the individual mandate, severability and Medicaid expansion, it’s easy to lose sight of the most important concept of health reform – and that’s affordability itself. It’s such a central concept that it is featured in the legislation’s name: The Affordable Care Act (ACA). Our discussions have lost sight of this.
Here in Colorado, we have new, and alarming, information on the “state of affordability.” At the very least, it serves as a cautionary tale about the work we need to do to change consumer expectations about “affordable” care.
The Colorado Health Access Survey (we call it CHAS) asked Colorado consumers about their willingness and ability to pay for health insurance. The difference between willing and able is a subtle one, but, bear with me, it is a helpful construct:
- One’s ability to pay is “fact based.” Do you have enough money to pay a little for your health insurance?
- One’s willingness to pay is “value based.” Do you value health insurance enough to find room in your budget to pay for it?
When we look at those Coloradans without insurance now (and it’s a big group, 830,000 strong), nearly 80 percent say they are able to pay something for their health insurance.
But when we ask about willingness (the value-based question) to pay, the plot thickens. More than 20 percent of those who said they were able turn around and say they are unwilling. And of those who are willing to pay something, 60 percent say they’d spend only between $1 and $150 a month on insurance.
When we line that up against the actual cost of health premiums, there’s a significant gap. And even with the subsidies posed by the ACA, the CHAS indicates that consumer education – and somehow changing how we value health care coverage - must change as well.
Another wrinkle in “affordability.”
PS – for more information check out the latest Issue brief.