The latest research and information on health insurance, accessibility and costs have most of us thinking, “we’re all mad here”. Over 14,000+ Hendricks County residents under the age of 65 do not have health insurance. For this 11% of Hendricks County, they are responsible for all their medical care on their own and out-of-pocket. Doctor visits, x-rays, prescription medicine and other services can cost thousands of dollars. If you have health insurance, a doctor’s visit for strep throat is usually $25. Without insurance, you might pay $125 for the visit (the antibiotics are usually another $200). If you broke your arm and had health insurance, you would pay about $200 to get it x-rayed and set. However, without insurance, you would pay about $2500.
Also in Hendricks County, up to 55% of households in each town qualify as ALICE households. ALICE is an acronym for Asset Limited, Income Constrained, Employed. These are households that earn more than the Federal Poverty Level, but less than the basic cost of living for the county. This unique demographic falls into a gray area for living expenses and assistance programs. These families are still considered above the poverty line and as such, they do not qualify for a substantial majority of assistance programs. 21% of the households in Hendricks County are ALICE households and 65% of jobs in Indiana earn less than $20 an hour, which means that more of us are considered in the ALICE household range and therefore we are less likely to afford basic needs. Let’s look at how this shapes the wonderland that is health care.
Curiouser and Curiouser
A survey done in 2018, found that 96% of Americans overestimate their understanding of health insurance. This means that while most of us are certain in our understanding of health insurance, we don’t know it nearly as well as we think. Insurance, in general, is a way to protect you from financial loss. The idea behind insurance is that when you purchase a plan or policy, you are sharing risk rather than taking it all on yourself. Health insurance specifically is designed to help cover the costs of getting medical care. When you have insurance for healthcare, you pay part of the cost of the care and the insurance company pays the other part. Still, medical costs can add up quickly.
Between rising health costs and a gap in understanding insurance, it isn’t entirely surprising that the number one reason people go bankrupt in the US is due to medical debt. 26% of Americans, 18 to 64 years old, struggle to pay medical bills. Since 2009, medical insurance premiums have risen by a whopping 54%, while income and earnings have only increased by approximately 26%.
Our article on health care costs for Hoosiers covers, in detail, the amount of money Hoosiers spend annually on healthcare. Knowing that, what are the options for those of us who don’t have insurance?
You may now be thinking- “wait, I thought everyone had to have insurance now, or they got fined or in trouble?”
You aren’t entirely wrong, in 2016 the U.S. Federal Government introduced a fee to be paid during tax time titled the “Shared Responsibility Payment”. This fee was determined on income, household status and size, and other details. It also was subject to change each year. The fee was in effect from 2017 to 2019. As of 2020, the federal government eliminated the Shared Responsibility Payment. So moving forward, there will be no fees attached to those without insurance at the federal level. States do have the option to implement their own fees by state taxes if they want. As of now, there is no information on Indiana and the potential to adopt this type of fee on the Indiana Government website. There are many reasons some families do not have insurance and some of that is access and fees.
As was said above, a considerable portion of Hendricks County is considered ALICE households. For these households, the “living budget” far exceeds their earnings but still places them above the poverty line. Most of the families in Hendricks County actually earn less than the minimum living budget recommendations of the government. These households do not have adequate access to assistance programs, so what do you do when you can’t afford health insurance or qualify insurance assistance programs like medicaid?
Where would you cut your budget to accommodate health insurance premiums, copays and out-of-pocket expenses? Do you cut spending on food? Perhaps you eliminate the child care services you use, but then what do you do when you’re at work? Do you cut spending on transportation or housing?
What Do You Do?
Most of us in Hendricks County will need to rely on the federal health exchange if we want to receive health insurance. This can be a tricky to navigate process that is time intensive and a bit confusing. The State of Indiana does provide resources for those who need to use this method of receiving insurance options. For those of us who still don’t qualify or who qualify for programs we still can’t afford there are other options.
At HOPE Healthcare Services, we work to provide these options in a way that promotes wellness for patients and ALICE populations rather than simply suggesting they get an insurance plan. For example, programs like ours provide medical care at a cost that is affordable. It allows more of our community to afford regular visits, labs, prescriptions, dental care as well as other services. It is rare for an individual without insurance to seek preventative care services, as they are often considered an unnecessary expense. A study, conducted by a group of doctors nationwide, found that not having continuous health coverage led people to avoid seeking care by over 4 times more than those who do have continuous coverage. They also found having intermittent coverage or no coverage led to a largely increased risk of having no preventive care services.
Preventative care services include blood pressure monitoring, cholesterol screening, diabetes screenings, cancer screenings, health counseling services, vaccinations and more. The law requires these services to be covered by insurance plans created after March 2010. This expanded access to these essential medical tests, but for those without coverage, preventative care is one of the first medical services we tend to give up. This can be risky and costly, in the long run, as these services are often credited for preventing illness and catching serious issues early like cancer and diabetes. Those of us without insurance tend to wait until symptoms become severe before seeking medical advice. And when we do seek advice, since we have not had continuous coverage, we often also do not have a care provider that we continue to meet for long term care like a primary care provider or general physician.
This is not a positive pattern for continued health. Some programs, like ours at HOPE, fill this gap by helping develop plans for wellness. We have worked with area vendors to provide significant discounts, sometimes up to 90%, on labs, imaging and sleep studies. Also, prescription assistance is provided by helping patients to make use of pharmaceutical companies free or reduced-price programs. Checking a patient and diagnosing a condition without the patient actually being able to afford the medication or lab work can be detrimental to the patient’s mental and physical health. By partnering with our area vendors, patients can be put back on the path to accessible healthcare and wellness. These programs have saved patients an estimated $90,000 through discounted labs and radiology services. They have also saved patients over $520,000 in medication costs in 2019.
HOPE Healthcare Services is one of the viable options for the 21% of Hendricks County who qualify as ALICE households and the 11% of the county who remains uninsured. We are here to help Hoosiers who lack health insurance of any kind. We know that the high prices of healthcare and insurance can be a barrier to health and wellness for Hoosiers. Our variety of low-cost healthcare services focus on providing care for those who are uninsured in our community and providing educational information related to health to all our neighbors. You can read more about our services here: https://www.myhopehealth.org/services