We launched a coalition to lower out-of-pocket costs and help end medical bankruptcies

The Lower Out-of-Pockets NOW coalition includes health care, business, patient, consumer and social justice organizations and will push for insurance reforms that lower and cap out-of-pocket costs.

I apologize for not writing in recent days, but my team and I at the Center for Health and Democracy have been preparing for a big announcement and event. You are among the first to hear about it.

Today, as members of Congress return from their recess and get to work on budget reconciliation, we are launching an urgently-needed coalition to make sure lawmakers are aware of how health insurance plans with high – and constantly increasing – out-of-pocket requirements are forcing millions of middle-class American families deep into debt – and many into bankruptcy. 

The Lower Out-of-Pockets NOW coalition comprises representatives from health care, business, patient, consumer and social justice organizations and will push for insurance reforms that lower and cap out-of-pocket costs. That is especially important for beneficiaries enrolled in traditional Medicare and Medicare Part D, as well as the privately insured and COVID-19 patients who now face financially crippling out-of-pockets because insurance companies will no longer waive COVID-19-related out-of-pocket requirements. 

High out-of-pocket requirements are a major reason for medical bankruptcies in the United States. More than 40% of people who have coverage on the individual market—and nearly 30% of people with coverage through their employers—are underinsured and more likely to forego needed care, according to the Commonwealth Fund. Those enrolled in privately operated Medicare Advantage plans can also be required to pay thousands of dollars before their insurer will cover their care.

Individuals enrolled in private marketplace or employer-based health plans in 2021 can be on the hook for $8,550 in out-of-pocket expenses. Many families have to pay $17,100 out of their own pockets before their coverage kicks in. Those most affected are people with modest incomes, people of color, and those living with chronic conditions.

Congressional leaders face an enormous task in identifying health care measures to fund as part of the proposed $3.5 trillion budget reconciliation package. As they begin their deliberations, it is imperative that they address the immense burden of escalating out-of-pocket health insurance costs.

Millions of Americans face bankruptcy or forgo health care every year because their deductibles, co-pays, or coinsurance are too high. They’re skipping visits to the doctor and walking away from the pharmacy counter without their medications, even life-saving drugs.

These are people who have health coverage, people with Medicare, private employer-sponsored health insurance or marketplace plans through the Affordable Care Act. 

Millions more Americans have health coverage today than a decade ago, thanks to the ACA. The problem is that many can’t afford to use it. We have traded a crisis in coverage for a crisis in underinsurance and unaffordable out-of-pocket costs.

Insurance reforms that lower out-of-pocket costs for all Americans – particularly Medicare beneficiaries – must be a top priority for Congress. 

Below are the charter members of the coalition. Please check out our website here.

Lower Out-of-Pockets Now Coalition Members:

• American College of Emergency Physicians

• American College of Obstetricians and Gynecologists

• American Public Health Association

• Business Leaders for Healthcare Transformation

• Center for Health & Democracy 

• Committee to Protect Health Care

• Consumer Watchdog

• Doctors for America

• Families USA

• First Focus on Children

• Good Days

• Just Care USA

• Let’s Rethink This

• The Mended Hearts, Inc.

• National Rural Health Association

• No Patient Left Behind

• Patients Rising

• Small Business Majority