While politicians in Washington, D.C. debate about whether to replace Obamacare with Trumpcare or something else, an important fact appears to be getting lost in the shuffle: Increased availability of health insurance hasn't brought down healthcare costs. A recent survey from Bankrate (NYSE:RATE) underscores just how significant a problem this is.

The Bankrate Money Pulse survey, conducted in May, found that millions of Americans skipped medical care because of high costs. For many, it wasn't because they didn't have health insurance; they opted to go without treatment because their out-of-pocket costs were too steep. Here's how the survey findings put the current debate over healthcare reform in a different light.

Sick woman on sofa

Image source: Getty Images.

Availability of health insurance isn't enough

Around 25% of Americans have forgone medical treatment or had someone in their family do so because they couldn't afford it, according to the Bankrate survey. It would be easy to blame lack of health insurance for this high percentage. But that can't be the primary factor.

The main reason Americans are skipping medical care is not that they don't have insurance. To understand this, we need to look at another survey. The Centers for Disease Control and Prevention (CDC) announced survey results in February that found 8.8% of Americans didn't have health insurance. If we combine the results from both the Bankrate and CDC surveys, it becomes obvious that many Americans who do have health insurance are still opting to go without medical treatment because of costs.

The Bankrate survey provided more detail on which age groups are more likely to forgo medical care. Here's the breakdown:

Bankrate survey chart

Data source: Bankrate. Chart by author.

Millennials (individuals ages 18 to 36) are the most likely to decide not to seek medical care because of cost. The Bankrate survey found that one in three older millennials (ages 27 to 36) chose to not go to a doctor or other healthcare professional because they couldn't afford it.

High deductibles equals high costs for Americans

One response to the Bankrate survey largely explains the problem. A 44-year-old single mother from Waltham, Massachusetts said that she had health insurance but still didn't go to the doctor because her deductible was so high. She's not alone.

The 2016 Kaiser Employer Health Benefits Survey found that the percentage of workers in health insurance plans with high deductibles increased from 4% in 2006 to 29% in 2016. Roughly 65% of employees of small organizations with three to 199 employees had deductibles of more than $1,000. In 2006, only 16% of workers in small organizations had deductibles that high.

Deductibles are also high for Americans who don't receive coverage through their employers. For the lowest-cost Obamacare plan, the average deductible for individuals in 2017 is more than $6,000. Families enrolled in Obamacare bronze plans have average deductibles of more than $12,000.

Trumpcare could cause deductibles to go even higher. For one thing, the proposed healthcare bill that passed the U.S. House of Representatives provides incentives for Americans to use health savings accounts (HSAs). HSAs are joined at the hip with high-deductible health plans. Drew Altman of the Kaiser Family Foundation thinks that under Trumpcare, health insurers would pay less of their members' medical expenses. As a result, he projects that average deductibles could increase by 61%.

Worried couple looking at healthcare bills

Image source: Getty Images.

A feature, not a bug

While Americans worry over higher healthcare costs that they must pay, it's important to understand why deductibles are going up. Both Obamacare and Trumpcare raised deductibles with the hopes of lowering healthcare costs overall.

When people have to pay for anything out of their own pockets, they are more likely to think twice about whether the expense is worth it. They're also more likely to shop around to get the best price. That's actually a good thing in many respects.

The Bankrate survey didn't provide details as to the outcomes of the individuals who decided not to seek medical care. It's possible that in many cases, medical care wasn't actually needed. If people don't have to pay to go to the doctor, they're more likely to go even when it isn't necessary.

On the other hand, high deductibles could end up increasing overall healthcare costs. For example, suppose a person doesn't go to the doctor initially because of the cost. If the condition proves to be serious, failure to receive treatment early could result in much higher medical costs later.

Whether the overall impact winds up being positive or negative, one thing seems likely: Americans won't pay less for healthcare anytime soon.

Keith Speights has no position in any stocks mentioned. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.