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Half of Obamacare customers cut back on care to manage costs, study says

Obamacare
Joe Raedle | Getty Images

Obamacare customers are acting more cost-conscious than other people with insurance — and it could be affecting their health.

A new survey finds that 50 percent of people who buy health plans through government-run Obamacare marketplaces say they cut back on getting health care services as they try to manage costs.

That can include not going to the doctor as often when they're sick, skipping preventative care visits and lab tests, and delaying elective surgeries.

In contrast, just 33 percent of all people with any form of insurance report cutting back on health care to manage costs, according to the survey by GfK, a marketing and customer research firm.

The same survey found that Obamacare marketplace customers with lower incomes, less than $25,000 annually, are much more likely to use what are often lower-cost urgent care facilities and "minute clinics" to get health services than Obamacare customers with higher earnings.

GfK found that 27 percent of lower-income Obamacare customers visited such a walk-in clinic in the past year, compared with 12 percent of all Obamacare customers.

Among all Obamacare customers, about one out of every four said they have switched to a lower-cost health plan to save money. Yet despite being more cost-conscious than all people with insurance, just 6 percent of Obamacare customers reported shopping around among health providers to find a better prices. That's only marginally more than the 4 percent of all people with insurance who said they shopped among providers based on price.

GfK's survey was based on questions answered by 921 insured adults, including 48 who buy health coverage through an Obamacare exchange. An extra sample of 253 exchange customers was added to the sample to provide broader findings.

Liz Reyer, vice president of consulting at GfK and lead for the company's health insurance practice, said the findings about people cutting back on care could reflect higher deductibles that many Obamacare plans have compared with employer-based insurance.

But she added that they also could reflect the relative financial position of Obamacare customers.

Reyer said the cost of health insurance premiums as a percentage of income is likely higher for many Obamacare customers, making them more conservative in spending money on services that would require them to pay out of pocket in the form of co-payments, coinsurance and deductibles.

But Reyer also noted that the survey didn't look at how previously uninsured people who now have Obamacare managed their health-care costs before. It's possible, she said, that those people were more likely to cut back on care beforehand, when they didn't have insurance, than they are now.

"The 50 percent might be better than it was," she said.

Reyer said the increased likelihood of lower-income Obamacare customers to use urgent care facilities and minute clinics might also reflect their concern about saving on out-of-pocket charges. But she added that those customers also may be driven there by habit, having used such lower-cost facilities when they didn't have insurance.

"I think it's a combination of habit and price consciousness," she said. "If they haven't met their deductible and they're going to pay out of pocket, clearly the clinic is going to be cheaper than going to a primary care doctor."

Reyer said the findings represented a "huge opportunity" for doctors, hospitals, and health plans to educate customers about how to use their plan effectively, and to minimize costs.

Although walk-in health centers can cost a customer less under their health plan, that isn't always the case. That's particularly true if the customer is receiving preventative care, which under Obamacare requires no out-of-pocket payment, or if they've already reached their deductible limit.

Many low-income Obamacare customers qualify for subsidies that can lower the cost of their out-of-pocket expenses. That financial aid is in addition to the subsidies that most Obamacare customers get to lower the cost of their monthly premiums, the payments they make to stay enrolled in coverage.

Reyer said the fact the overwhelming majority of all people with insurance are not shopping around for health providers based on cost is "the biggest indictment of the high-deductible model" gaining popularity in the health insurance sector. That model is based on the theory that structuring a health plan so that it has higher out-of-pocket charges for customers is a way to control health-care costs because consumers will be more price conscious, and shop more.

"Going around and shopping when you're sick?" Reyer said. 'It's profoundly not fun."