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Half of Americans could hunt for new health coverage

An imminent Supreme Court decision in King v. Burwell is one of the most closely watched ever. The High Court will decide whether the federal government under the Affordable Care Act (ACA) can offer health care insurance subsidies to low- and middle-income people if their states haven't created their own exchanges for selling health care coverage.

While political parties and the health care and insurance industries are paying close attention, so too are consumers. And results of a new survey suggest that 51 percent of Americans -- far more than receive subsidies -- would immediately look for new insurance should a decision undercut the financial assistance plan.

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The study by TransUnion questioned approximately 7,400 people, all of whom had household experience of requiring health care in the last two years. It found most were concerned that a reduction in subsidy eligibility would mean fewer people paying for insurance and, as a result, higher costs for everyone.

"We didn't think people who weren't on subsidies were paying close enough attention to what was happening in the Supreme Court and the overall effect it would have," Gerry McCarthy, president of TransUnion Healthcare, told CBS MoneyWatch. "They think the Affordable Care Act is helping to control costs in the long run and, if it were to go away, it would increase their own costs and out-of-pocket expenses, which would cause them to shop (for other health care providers)."

The point of contention in King is whether the wording in the ACA allows the federal government to legally offer subsidies to people who live in states that didn't implement their own insurance exchanges. It isn't clear how a reduction in overall enrollment would affect rates for people in general.

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If more people pay premiums, it could allow costs to be spread among a wider base, potentially lowering expenses for all individuals, although the people who are newly insured may have long-ignored problems that increase the total expense of care. Yet, if those newly insured lose their coverage, "it takes costs out, but it puts significant burdens on providers" because of the increase in charity care cases, said McCarthy.

TransUnion found that concern over health care costs, and how much individuals might owe under their specific plans, has ballooned. Seventy-nine percent of patients said knowing up-front what they will be responsible for after all the specifics of their coverage are taken into account was as important to them as a doctor's bedside manner.

About 55 percent were confused by health care bills, while 61 percent were sometimes or always surprised by out-of-pocket expenses. While 85 percent of respondents thought pretreatment cost estimates could help them better manage medical costs, only 30 percent of hospitals routinely offer such estimates. Those who thought an installment plan would help them cope with medical bills went from 40 percent last year to 47 percent this year.

"All other things equal, consumers will look at [a health care provider] who is cheaper," McCarthy said.

A big reason for that is many people don't have the financial resources, even with insurance -- particularly high-deductible plans combined with low emergency savings rates and low to medium income -- to cope with a major health problem. "Any type of medical condition happens," said McCarthy, "people are automatically underwater."

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