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Checkup rates the same for exchange and employer-provided health coverage

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People enrolled in public health insurance exchanges and receiving government premium subsidies are receiving routine medical checkups at the same rate as lower to middle-income workers enrolled in their employers’ health plans, according to a new survey.

The survey released Monday, which was funded by the Robert Wood Johnson Foundation and the Urban Institute, found that 67.6% of both groups had a routine medical checkup in the past 12 months.

The researchers last September surveyed 4,500 people with incomes between 100% and 400% of the federal poverty level—the income range that uninsured individuals must be in to be eligible for exchange premium subsidies. For example, in 2016, subsidies are available in 2016 for a family of four with an income of up to $97,000.

Researchers say the finding is encouraging as it shows that a key Patient and Affordable Care Act objective — getting more people to have checkups to spot medical problems before they develop into expensive complications — is being met.

“These numbers are really reassuring. The system has been able to meet demand and care is being delivered,” said Katherine Hempstead, senior adviser for health care at the Robert Wood Johnson Foundation in Princeton, New Jersey.

In addition, just 7.7% of exchange enrollees had trouble finding a doctor as a new patient in the past 12 months compared with 5.4% of employees.

Still, even with health insurance, 25.6% of exchanges enrollees and 24.5% of low- to moderate-income employees with coverage through their employers said they had problems paying family medical bills in the past year, reflecting the plans’ high cost-sharing requirements.

For example, 21.2% of surveyed exchange enrollees and 23.7% of those with employment-based coverage reported out-of-pocket health care costs of $1,500 or more in the past 12 months.

The survey also found that 25.4% of exchanges enrollees were dissatisfied with the premium they paid for the coverage, slightly more than the 20.8% of low- to moderate-income respondents who were dissatisfied with premiums their employers required them to pay for coverage.

Even with federal premium subsidies, the premium for exchange coverage “can be a lot of money” for enrollees, Ms. Hempstead said.