Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — Thousands of Kansas families are likely to benefit from a provision in the Affordable Care Act that limits out-of-pocket medical expenses, according to a study by Families USA, an advocacy group representing health care consumers.

“We believe these caps, which are not well-known and have not received much coverage, will have a profound impact on making health care affordable,” Families USA Executive Director Ron Pollack said during a Tuesday teleconference with news reporters.

The teleconference focused on four states: Georgia, Illinois, Texas and Kansas.

The caps – roughly $5,950 for individuals, $11,900 for families – take effect in 2014.

Based on national census and health-care spending data, the study found that in Kansas, 156,200 people under age 65 are in families that are likely to exceed the caps by 2011.

“I think it’s safe to say that by 2014, the numbers will be even higher,” Pollack said.

Collectively, these Kansas families’ out-of-pocket expenses, he said, are expected to exceed the cap by $232 million a year between 2011 and 2014.

In Kansas, the average family includes 3.14 people, according to the U.S. Census.

Almost two-thirds of the families likely to be affected by the caps will have at least one adult who is working full-time. Of these adults, 68 percent work for companies with fewer than 100 employees.

Kansas’s numbers, Pollack said, are not unique.

“I’m not sure there’s anything idiosyncratic with Kansas,” he said. “In every state, there are huge numbers of people who need help on both ends of the equation – those who are uninsured because they can’t afford the premiums and those who, even if they are insured, can’t afford the out-of-pocket expenses.”

In 2014, Pollack said, companies that sell health insurance through the state-run exchanges will be required to include the caps on out-of-pocket expenses in their policies.

The caps, he said, will be subject to a sliding scale based on household income.

“The less you earn,” Pollack said, “the lower your ceiling.”

Insurance companies, he said, are expected to include the cost of the caps in the premiums.

Kansas Health Consumer Coalition Anna Lambertson read the report Tuesday.

“It’s always hard, I think, to come up with an exact number for how many people will be affected by a policy that’s three years away,” Lambertson said. “I won’t argue with their numbers. But I will say that, based on the calls we get every day, people are really struggling – even if they have insurance, they can’t afford to pay for all the things that aren’t covered. They’re putting it on their credit cards. They’re going into debt. They’re filing bankruptcy.

“A lot of people are under incredible stress right now,” she said.