The LOOP NOW Coalition sent a letter to Congressional leaders asking them to introduce bipartisan legislation to begin reducing Americans’ exposure to absurdly high out-of-pocket requirements.

Americans are being buried under a mountain of medical debt – including people with health insurance. 

Kaiser Health News reported last year that 100 million adults in America are carrying medical debt. Even if that figure includes every one of the approximately 30 million of us who are uninsured, that would still leave 70 million who have insurance.

The leading reason for this growing medical debt crisis is unaffordable out-of-pocket costs our insurers and employers now require most of us to pay before our coverage kicks in. 

One of the reasons I left Cigna was over this issue. Cigna and all the other big insurers were determined to move all of us as fast as possible into high-deductible plans. Not long before I left, Cigna as an employer eliminated the low- or zero-deductible plans employees had been enrolled in, leaving us with no option other than a high-deductible plan. And the company encouraged its employer customers to follow suit. Many, if not most, did.

I knew the herding of Americans into high-deductible plans would be great for insurers’ profits but calamitous for millions of families. My ongoing analyses of big insurers’ quarterly earnings reports bear this out. All the big for-profit insurers are posting record profits as more and more of us with insurance are forced into bankruptcy after an illness or injury.  

It didn’t take a lot of persuasion for me to organize and lead a coalition of organizations to demand that policymakers, employers and insurers take steps to bring relief to the growing number of Americans with insurance who are dying prematurely or being forced into bankruptcy because of sky-high out-of-pocket requirements. Nearly 70 organizations have joined the Lower Out-of-Pockets NOW coalition, which we formed solely to focus attention on this runaway crisis. It has grown to become one of the most broad-based coalitions I’ve ever seen. Members include groups representing patients (especially those with chronic conditions), employers, physicians and other caregivers, and health care reform advocates. 

This week, we sent a letter to Congressional leaders calling on them to introduce bipartisan legislation to begin reducing Americans’ exposure to absurdly high out-of-pocket requirements. We then sent the letter to every member of the House and Senate. See the letter below:

We’re asking Congress to start addressing the cost-sharing crisis by capping out-of-pocket costs for prescription drugs at $2,000 annually for people enrolled in Affordable Care Act (Obamacare) marketplace plans – and total out-of-pocket costs at $5,000 annually. This is in line with the provision of the Inflation Reduction Act (IRA) that will cap out-of-pockets for prescription drugs at $2,000 a year for Medicare beneficiaries beginning in 2025.

One of the most short-sighted and unfortunate provisions of the Affordable Care Act is the one that allows the maximum out-of-pocket limit to increase every year for all privately insured Americans. This year, individuals can be on the hook for up to $9,100 before their coverage kicks in. For a family, it’s $18,200. It’s no wonder so many of us are having to make choices between putting food on the table and getting the care we need. When we go to the doctor or pharmacy counter, we find out all too often that our share of the bill is beyond our ability to pay.

As we point out in the letter, ACA marketplace plans are just the starting point. Most of us get coverage through our employers, so Congress – and employers – must also begin to get serious about how to bring down out-of-pocket costs for all of us.

Congress is doing important work in this area, not just with the IRA but through a bipartisan effort to address the greed of the big middlemen in the drug supply chain – pharmacy benefit managers – the biggest of which are now owned by big insurers, including Cigna. We are working with Congress on those efforts, primarily to ensure that any bills they pass result in real savings for American families. 

Almost immediately after the LOOP Coalition sent the letter to Capitol Hill, we started getting positive emails from members of Congress on both sides of the political divide. I’ll be writing plenty more about this issue in the weeks and months ahead.