weather icon Mostly Cloudy

Report examines Americans ‘priced out’ of health insurance

Updated March 7, 2019 - 6:07 pm

A Las Vegas couple in their early 60s making $65,800 a year can receive nearly $1,200 in monthly subsidies from the federal government to buy health insurance.

But if their income increased by just $100 a year, the subsidy would vanish and health insurance would cost them about one-third of their annual income.

The fact that health insurance can be unaffordable for a swath of middle-class Americans is not new. But an analysis released this week by the Kaiser Family Foundation paints a more detailed portrait of those who either struggle to make their premium payments or simply go without.

“Even though it’s less than 5 percent of the population, it’s gotten 95 percent of the media coverage,” Cynthia Cox, an author of the report, said of the plight of middle-class customers who must pay full price for their policies or do without. “I think from both the left and the right, this is seen as a problem.”

By the KFF’s estimates, roughly 1.6 million people nationwide bought unsubsidized coverage through their state marketplace (such as Nevada Health Link in the Silver State). Another 4 million found health insurance outside the state exchange.

About 1.9 million others didn’t buy coverage at all and had incomes above 400 percent of the federal poverty level — the cutoff to qualify for a subsidy.

‘Priced out of the market’

“Those are people who you might say are priced out of the market,” Cox said, adding that most of those people are likely older Americans.

Per federal Affordable Care Act regulations, health insurers can’t discriminate against patients based on their health conditions. They can, however, charge people who are older or live in rural areas more, and they do.

The report showed Nevadans who are 60, single and earning $50,000 a year would pay between 15 percent and 27 percent of their income just for health insurance premiums, depending on whether they live in urban Clark County or rural areas of the state.

That cost wouldn’t include the person’s coinsurance or copays or any costs from their deductible.

That may mean some local couples in their 60s simply can’t afford health insurance, said Jeremy Shugarman, a Las Vegas broker and past president of the Clark County Association of Health Underwriters. He said he had to help one senior couple disenroll from health insurance in the last month when they realized their income was just slightly higher than they’d estimated.

“I have a lot more people that are not getting help from the government than I do that are getting help,” he said. “(Health insurance) is affordable for people that are in the income bracket that allows them to get large subsidies on better plans.”

It’s nearly impossible for someone making just above 400 percent of the poverty level to pay for health insurance, said Cox, the coauthor of the Kaiser foundation report. Because the price of health insurance rises as you age, it would take a $500,000 annual income to be able to afford coverage for some customers. And not many Nevadans earn that much, especially those living in a rural areas.

Nationally some states are looking into reinsurance programs, which could decrease or keep steady health insurance premiums by offering reimbursements for insurers when patients rack up high bills. The approach, Cox said, has been largely bipartisan.

And some on the left in Congress have proposed expanding subsidies to a higher income bracket or enacting single-payer health insurance. Rep. Pramila Jayapal, D-Wash., for instance, introduced a “Medicare-for-all” proposal last month that effectively eliminates private health insurance.

Bill would add Medicaid option

In Nevada, association health plans have been made available through chambers of commerce in the north and south, offering comprehensive plans to small businesses and sole proprietors. And Assemblyman Mike Sprinkle, D-Sparks, is rolling out a bill to offer consumers a Medicaid buy-in option. Sprinkle has said such coverage would likely cost about the same as plans available on the marketplace today.

The real problem, according to Cox, are the high prices that Americans pay for medical care.

“We really don’t use more health care than other countries do … but we spend much more on the services we get,” she said. “This really is an issue of underlying prices of health care being so high in the U.S. compared to other countries.”

In the meantime, Cox said, Nevadans and middle-class residents of other states may have only one option: short-term, limited-duration plans. Such plans are often referred to as “junk” insurance because unlike ACA-compliant plans they are not required to cover 10 essential health benefits, including mental health care and prescriptions.

Nevada Health Link Executive Director Heather Korbulic said she’d never recommend them because of the unimpressive benefits.

Looking at the Kaiser data, Korbulic said she was surprised by the high insurance premiums in rural Nevada compared with the rest of the nation and indicated those numbers are worth further examination.

Still, she’s not optimistic the state’s budget could support solutions like a reinsurance program. Instead, those will require federal action, she said.

“If you think about it in the bigger picture for the state of Nevada, our public health and our economy are improved when people have access to health insurance,” Korbulic said.

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

Don't miss the big stories. Like us on Facebook.
Entertainment Videos
What it's like to skip the lines and fly by helicopter to EDC
What it's like to skip the lines and fly by helicopter to EDC. (Janna Karel Las Vegas Review-Journal)
Las Vegas Smith & Wollensky opens at The Venetian
After 18 years, the Smith & Wollensky location on Las Vegas’ south Strip closed in 2017, to be re-born two years later with a rib-cutting — instead of a ribbon-cutting — in The Grand Canal Shoppes at The Venetian. (Heidi Knapp Rinella/Review-Journal)
Colin Cantwell, Creator Of Iconic Star Wars Ships Visits Vegas
Colin Cantwell, who created and designed such "Star Wars" ships as the X-Wing fighter, and Death Star, met fans at Rogue Toys in Las Vegas today. (Mat Luschek / Review-Journal)
Beauty & Essex in Las Vegas makes an EDC Wonder Wheel
In honor of the Electric Daisy Carnival, Beauty & Essex at The Cosmopolitan of Las Vegas makes its Wonder Wheel party-worthy. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Giada talks Vegas Uncork’d
Giada De Laurentiis talks during Aperitivo Hour, a Vegas Uncork'd event, at her Caesars Palace restaurant, Pronto, May 10, 2019. (Al Mancini/Las Vegas Review-Journal)
Scenes from Vegas Uncork’d 2019 on the Las Vegas Strip
The 13th edition of Vegas Uncork’d by Bon Appetit brought four days of food, wine, celebrity chefs and parties to town, May 9-12. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Three ingredients Gordon Ramsay can’t live without
Bon Appetit's Andy Baraghani interviews the "Hell's Kitchen" chef during a Vegas Uncork'd event at Caesars Palace, May 11, 2019. (Al Mancini/Las Vegas Review-Journal)
Vegas Uncork’d launches wiith bubbles and a blade
Dozens of chefs representing some of the Strip’s top restaurants gathered Thursday at The Cosmopolitan of Las Vegas to launch the 2019 edition of Vegas Uncork’d by Bon Appetit. (Al Mancini/Las Vegas Review-Journal)
Bunky the Clown at the clown convention
Bob "Bunky the Clown" Gretton talks about his life as a clown and the Clown Convention which was in Las Vegas at Texas Station this week. (Mat Luschek / Review-Journal)
Frying soft-shell crab at Lola’s in Las Vegas
At Lola’s: A Louisiana Kitchen in Las Vegas, soft-shell crab is breaded and fried and served either as an appetizer, po’boy or platter. Heidi Knapp Rinella/Review-Journal
The Stove in Henderson makes Pecan Pie Pancakes
At The Stove in Henderson, chef/partner Antonio Nunez stacks buttermilk pancakes with pecans and dulce de leche and tops them pie crust crumbs. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Vinnie Paul remembered at Count's Vamp'd
The late rocker's favorite table at one of his favorite clubs in Las Vegas. (Jason Bracelin/Las Vegas Review-Journal)
4DX movie experience at Red Rock
4DX movie experience during a demo reel at Red Rock. (Christopher Lawrence/Las Vegas Review-Journal)
What To Do On May The 4th
There are plenty of events going on May the 4th this year around Las Vegas. Celebrate Star Wars and Comic Book Day all at once. The Rogue Toys, the 501st, Rebel Legion and Millennium Fandom Bar are all hosting fun events to help celebrate your geek-dom. (Mat Luschek / Review-Journal)
Las Vegas Water Sports Introduces New Attraction At Lake Las Vegas
Las Vegas Water Sports will debut its new aqua park attraction at Lake Las Vegas Days this weekend. (Mat Luschek / Review-Journal)
Making the Space Invader at Greene St. Kitchen in Las Vegas
Lysa Huerta, pastry cook at Greene St. Kitchen at the Palms in Las Vegas, starts with angel food cake, Fruity Pebbles ice cream and strawberry sorbet to create a space creature engulfed in flashing lights and swirling mists. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Las Vegas Pools
The M, Park MGM and NoMad are just a few great pools in Las Vegas. (Mat Luschek/Las Vegas Review-Journal)
Jose Andres explains Iberico pork
(Al Mancini/Las Vega Review-Journal)
Inside Life is Beautiful
Craig Asher Nyman explains how Life is Beautiful festival is booked and talks about this year's line-up. (Jason Bracelin/Las Vegas Review-Journal)
Tattoo'd America Pops Up In Vegas
Tattoo'd America, a new pop-up attraction on the Linq Promenade, had their grand opening Friday. The attraction is dedicate to the culture of tattoos. (Mat Luschek / Review-Journal)
Jose Andres gets key to the Strip
Chef Jose Andres was presented with a Key to the Las Vegas Strip and a proclamation declaring April 26 Jose Andres Day in Clark County by County Commissioner Tick Segerblom on Friday. The ceremony took place at his restaurant Bazaar Meat in the SLS Las Vegas. (Al Mancini/Las Vegas Review-Journal)
Sadelle’s in Las Vegas makes a grilled cheese with an inverted bagel
Michael Vargas, executive sous chef at Sadelle’s at Bellagio in Las Vegas, inverts an everything bagel and grills it with Swiss, cheddar and Muenster cheeses to make the Inverted Bagel Grilled Cheese. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Learn how to make China Poblano's Salt Air Margarita
Learn how to make China Poblano's Salt Air Margarita (Janna Karel Las Vegas Review-Journal)
Tattoo'd America invites you to have fun and take pictures
Kassandra Lopez at Tattoo'd America invites you to have fun and take pictures. (Janna Karel/Las Vegas Review-Journal)
Prime rib is carved tableside at Lawry’s The Prime Rib in Las Vegas
Dave Simmons, executive chef of Lawry’s The Prime in Las Vegas, which plans special cuts for National Prime Rib Day, demonstrates the restaurant’s service from rolling tableside carving carts. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Making gluten-free pizza at Good Pie in Las Vegas
Good Pie owner/pizzaiola Vincent Rotolo makes his gluten-free pizza.
Rockabilly fans enjoy Las Vegas weather poolside
Viva Las Vegas Rockabilly Weekender runs Thursday, April 18th through Sunday, April 21st with a huge car show on Saturday featuring The Reverend Horton Heat, The Delta Bombers and The Coasters. (Michael Quine/Las Vegas Review-Journal)
Brownie sundae at VegeNation in Las Vegas is completely vegan
Donald Lemperle, chef/owner of VegeNation in Las Vegas and nearby Henderson, NV, makes his sundae with ice cream made with coconut and almond milks, a brownie made with coconut flour and oil and organic sugar and cacao, and fresh fruit. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Taste of the Town: Henderson Booze District
Those who like to support local businesses and sample local products will find the best concentration in an unlikely spot: a Henderson industrial park.
Founder of Las Vegas theater talks about a favorite play
Ann Marie Pereth, founder of A Public Fit Theatre Company, speaks to the Review-Journal about which play she would see every day if only given one option. (Rachel Aston/Las Vegas Review-Journal)