The healthy uninsured low net worth individuals don’t want to be forced to buy something that they don’t need.
If they get really sick, the healthy uninsured, low net worth individuals can count on Medicaid and bankruptcy, so they have de facto catastrophic insurance. The high deductibles make any insurance coverage meaningless because the high deductibles are in fact financially catastrophic for a low net worth, low income person. So these people are paying for something that they really cannot use- what a waste. Moreover, because they are in an insurance plan, these individuals lose the right to directly negotiate with an in network provider for better rates for routine services or less expensive options that insurance may not considered covered which therefore are not applicable to the deductible. If they go to an out of network provider for less expensive routine services, these expenditures will typically not be counted towards their deductible.
Providers also realize that people with high deductible 0-care plans are poor credit risks because it’s the people with lower incomes that will typically need to select high deductible plans because that’s all they can afford. They are also more likely to not keep up with the insurance payments and lose their coverage because of lower disposable income. Providers know that if these people stop their insurance payments, the insurance company will not notify the provider for up to 60 days, forcing the provider to collect for unpaid services on a poor credit risk. Collection efforts are expensive (50%)and poor risk patients usually don’t pay. Not a good situation when reimbursement rates result in low margins. This has forced providers to ask to the money up front or refuse acceptance of 0-care patients. Hence the access difficulties.
Bkmk