Having health coverage isn’t the same as being covered

Something like one in seven people living in the U.S. have no health care insurance. In fact, the number of uninsured people has grown by 7 million since 2016. These numbers are atrocious. Embarrassing. Shameful, actually, in a country as wealthy as ours. We need to recommit ourselves to guaranteeing people access to affordable health care insurance.

And then we need to go one step further and make sure the insurance we offer is robust enough to allow people to receive necessary medical care without going bankrupt. Because currently, even when Americans do have health insurance, they often don’t have access to affordable medical care.

In the state of Massachusetts, for example, the rate of uninsured is significantly smaller than in the rest of the US, due to Romney Care (the legislation that served as a model for Obamacare). While around fourteen percent of people in the US lack insurance, that’s true for less than three percent of people living in Massachusetts.

But insurance isn’t the same as access. If your insurance doesn’t reimburse providers well, you will have a hard time getting medical appointments. You’ll call doctors up and discover, “They aren’t currently taking people with your insurance.”  Here’s data from Massachusetts in 2015, showing the surprisingly high percentage of people who have difficulty accessing medical care:

Prevalence of high uninsurance among nonelderly adults in Massachusetts, by population characteristics, 2014. High uninsurance is defined as more than twice the statewide uninsurance rate for all people in 2014 based on data from the American Community Survey (3.4 percent). Nonelderly adults are ages 18–64.

Having coverage isn’t the same as being covered. About one in five Massachusettians (Massachusetters?) have trouble getting medical care because of high out of pocket costs, despite having insurance:

Difficulties with health care costs among full-year-insured nonelderly adults in Massachusetts, 2015.

I’m not saying we should give everyone undiscerningly generous health care insurance that pays any price providers want to charge, and that cover’s patients’ costs regardless of how necessary services are to their health or wellbeing. Instead, I’m urging us as a country to provide decent insurance for everyone living here, insurance that pays providers a decent fee while exposing patients to low out of pocket costs for high-value services.

That shouldn’t be too much to ask from the world’s richest country.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Image credit: Shutterstock.com

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