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The Dangers of Lacking Quality Iowa Health Insurance

"Under-insured" Iowans closely resemble the uninsured: They act against medical advice in response to rising health care costs.

Table 1, below, shows the rate at which three groups of Iowans have acted against medical advice due to cost pressures. As the literature suggests, there is considerable difference in the behavior choices of insured and uninsured Iowans; but when it comes to not following up on scheduled tests, a majority of those who rate their plan as barely adequate have acted against medical advice due to cost pressures at a rate (51%) that exceeds the rate of the uninsured (41%). They have also decided not to fill a prescription due to cost at a higher rate than have the uninsured, 47% to 41%.

Table 1. Actions Iowans Have Taken Against Medical Advice in Response to Rising Health Costs
	Insured Iowans %	Health Insurance No More Than Barely Adequate %	Uninsured Iowans %
Have not scheduled tests suggested by their doctor	21	51	41
Have decided not to fill a prescription given by their doctor	20	47	41
Have cut back on the dose of a prescription drug to help the drugs last longer	16	35	35
Have stopped taking medication to avoid the cost of prescription drugs	15	42	32

To save money, insured Iowans have changed the type of health coverage they choose and the amount of health care they consume.

Overall, 26% of insured Iowans say they have switched to a health insurance plan with higher deductibles and co-payments; sixteen percent (16%) say they have switched to a plan with fewer benefits, and 14% have switched to a plan with more restrictions on access, all in the name of saving money. Among privately insured Iowans, 48% have migrated to a plan with higher deductibles and co-pays, and 32% have gone to a plan with fewer benefits. When it comes to restrictions on access, the privately insured find this option nearly as unpalatable as those with employer coverage: only 17% have switched to access-restricted plans. Almost half of insured Iowans (47%) report they try to minimize how often they use their health insurance coverage in order to help keep overall premium costs for everyone in their coverage group from rising. Insured Iowans with incomes below $50,000 are more likely to try to minimize use of their health insurance than Iowans with incomes of $50,000 or above (55% compared to 42%, respectively). Rural insured Iowans are also more likely to say they try to limit their insurance usage to keep premium costs down (55% compared to the overall average of 47%).

Interpretation

Regardless of insurance status, when Iowans choose not to follow professional advice so they can save on immediate medical care expenses, there is the possibility that negative health outcomes may follow. Ignoring medical advice can degrade the effectiveness of an already dispensed treatment regimen. Alternatively, the refusal to follow advice can lead to delays in starting necessary care. Either result increases inefficiency within the health care delivery system, which in turn leads to higher costs due to the need for more aggressive treatment regimens at a later point in time, potentially including increased hospital and nursing home admissions.

Policy makers and health care reform advocates often focus on the uninsured when they look at how increasing health care costs contribute to medical vulnerability. While the results of this survey confirm that uninsured Iowans do make choices that may increase their medical vulnerability at a higher rate than insured Iowans, the real story in these data is how increasing medical care and health insurance costs are also pushing insured Iowans to make potentially detrimental health care choices. The insured who rate their plans as barely adequate may well be the canaries in the coal mine. Their behaviors serve as a warning to policy makers that as health care costs are increasingly shifted to insured persons, with little account taken of cost exposure and underlying health status and income, there is a significant risk that individuals, families, and society will be without adequate protection from the health risk and expenses of forgone medical care.

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