When it comes to healthcare, Americans may not agree on much, but they agree on this: Affordable, quality coverage is getting further out of their reach. 

That's a key finding of Consumer Reports' second Consumer Voices Survey, a nationally representative poll of 1,007 adults conducted in April. When people were asked what their biggest concern is right now as consumers, healthcare issues were most often cited—mentioned by almost a quarter of respondents.

And the survey found that Americans' concerns about healthcare have ratcheted up significantly since the start of the year.

Cost is a major worry: More than half of Americans (57 percent) say they lack confidence that they and their loved ones will be able to afford health insurance.

Quality of care is another: 41 percent now say they are not confident that they will have access to the doctors, tests, treatments, and medications they need. That’s up from 35 percent in January when we first asked the question—a statistically significant jump.

And we heard that consumers have both struggled with steep increases in the past few years and worried about what will happen now.  

Democrats and Republicans in Congress have starkly different ideas about how to fix American healthcare. The Republican plan that the House passed May 4th will give more power to states to decide what benefits are covered and will let insurers price coverage in part on the insured person's health status. More changes are expected from the Senate.

Democrats say reforms should build on the existing law, the Affordable Care Act (ACA), fixing the parts that need to be improved.

The debate has reanimated central questions about how deeply government should be involved in its citizens' personal welfare.

When asked in our survey whether the government should help make sure people have access to affordable, quality healthcare, the vast majority of Americans—78 percent—said “yes.” While almost all Democrats answered that way, so did 80 percent of Independents and 56 percent of Republicans.

“When more than half of Republicans, the party that's been trying to repeal the ACA for seven years, say they want their government helping people afford quality healthcare, that shows that this is an issue that is important to a lot of people,” says Chris Sloan, a senior manager in the policy practice at Avalere Health, a healthcare consulting firm.

Fear of Losing Protections

In addition to conducting a survey, CR also asked consumers to share their own thoughts as the future of the nation’s approach to health insurance is being debated.

“I am very concerned about the future of our healthcare,” says Sue Jesch, 63, a self-employed violin teacher in Carson City, Neb. She was  diagnosed with Parkinson's disease last year, she told us in an interview, and gets health insurance through the marketplace exchanges created by the ACA—insurance she says she wouldn't be able to afford otherwise.

Read More About Healthcare Reform

Before the ACA, people with pre-existing conditions such as Jesch were often denied insurance or charged much higher rates than healthy people. Though the American Health Care Act (AHCA), the Congressional Republican plan to repeal and replace the ACA, still requires that insurance companies cover people with pre-existing conditions, it gives states the ability to allow insurers to charge those people more if they have a gap in coverage of 63 days or more.

A new report from the nonpartisan Kaiser Family Foundation estimates that could mean higher premiums for 6.3 million people with pre-existing health conditions.

The ACA also provided new protections to people whether they bought insurance on their own or got it through their employer, says JoAnn Volk, a professor and project director at Georgetown University’s Center on Health Insurance Reforms.

For example, under the ACA, employers can’t impose a waiting period for coverage of a pre-existing condition. Before the law, you might have had to wait up to a year for your employer plan to cover pre-existing health conditions.

The ACA also requires that all insurance plans cap the amount individuals are expected to pay out-of-pocket each year. And it prohibits employer plans from having an annual or lifetime dollar limit on benefits.

Cost Concerns

Another major concern for people who get insurance through their job or the marketplace is rising premiums.

People with employer-based insurance—about half of all Americans—have seen their premiums rise sharply for years. Since 2011, those rates for families have increased 20 percent, according to research from the Kaiser Family Foundation.

Many employers have responded to those rising premiums by offering their workers “high-deductible” health plans, which usually have lower premiums. But in exchange for those savings, people pay higher deductibles, or the amount they pay out of their own pocket before insurance begins to kick in. Those deductibles in high-deductible plans average about $2,300 for an individual, according to KFF.

A quarter of all U.S. companies offered only high-deductible health plans in 2015, almost double the number in 2013, according to the consulting firm PwC.

And more than half of all covered workers now have deductibles of at least $1,000 for an individual.

Neal Wheeler, 60, feels that sticker shock. The Tracy, Calif., resident says that the monthly premium for his employer health insurance, which also covers his wife, went from $400 per month before the ACA to $1,200 today.

“Co-pays and deductibles are so high, I can’t afford to use my insurance,” he says. “I fear that at this point the repeal of ACA won't fix the problems. Will our rates suddenly go back to a reasonable amount? Ha.”

High-deductible plans are also the norm in ACA plans. Last year, two-thirds of people on the exchanges signed up for Silver plans, which have relatively low premiums but average $3,572 for individual deductibles in 2017, according to the health insurance data website HealthPocket. “No matter where they get their insurance, costs are rising and people are paying more out of their own pocket," says Sloan, from Avalere Health. "The cost of healthcare is a concern for everyone.

Growing Frustrations

The protracted debate among lawmakers about how to fix healthcare contributes to Americans' growing sense of unease, according to consumers who have shared their thoughts with CR.

Lisa and Glenn Lowenstein, of Houston, count themselves among the frustrated. Both are small business owners, she running a veterinarian clinic and he an environmental consulting company. They have ACA health insurance for themselves and their 18-year-old son, a high school senior.

Lisa says she is no fan of the ACA, having seen the family’s premiums rise substantially in the past few years, making it harder and harder for the family to afford healthcare.

 

Are you worried about healthcare costs? Join Consumer Reports' efforts to #ProtectOurCare.
 

But premium increases on plans sold on ACA exchanges tended to be higher in states such as Texas that didn’t expand Medicaid, which pushed a larger portion of people onto the exchanges, including a larger number of sick ones, who are more costly to insure.

And under the AHCA they could be in even worse shape, because that law allows insurers to charge people in their 50s and 60s much more than younger people.

“I would like to see truly affordable care that the average person can pay for. I totally believe that people with pre-existing conditions need to be covered. I think it’s good that more people have insurance,” Lowenstein says. “I know medical care is expensive. But there’s got to be a better way to do it than what we're doing now.”