I can't address your speculative claims on how lower-income folks think about health care, but to give a concrete example of a positive preventive outcome:
- A 55 year-old woman making $30,000 a year purchases insurance through the Exchange. She pays:
-- $2,512 for the year's premiums ($209 per month)
- She receives a preventive breast exam (no cost) that is positive for breast cancer.
- She receives comprehensive treatment costing $60,000.
- Because she is at 261% of the federal poverty level, she stops paying out of pocket at the maximum of $2,975.
She would have gotten the treatment anyway. Filed bankruptcy and as a renter lost nothing, except her next car costs 5% more because her interest rate is higher.
Charities often have strict income limits regarding those who they will serve. Some of the charities your link mentions state they can only serve a limited number of patients. Many of the programs are in a single county. You may end up having to call around to many programs to only find out you don't qualify for any of them. If you have insurance through your employer, it may have a huge deductible and even if it does cover a mammogram it may not cover treatment. These factors all discourage people from getting preventative medicine done.
Bankruptcy should never be regarded as a valid solution for medical care costs. What if her state has rules that don't allow her to keep her car(or certain other items) when filing for bankruptcy? What if she had already filed for bankruptcy the year before?
- A 55 year-old woman making $30,000 a year purchases insurance through the Exchange. She pays:
-- $2,512 for the year's premiums ($209 per month)
- She receives a preventive breast exam (no cost) that is positive for breast cancer.
- She receives comprehensive treatment costing $60,000.
- Because she is at 261% of the federal poverty level, she stops paying out of pocket at the maximum of $2,975.
- Her total costs paid for the year are $5,487.
($2,975 in cost-sharing [2] + $2,512 in premiums)
[1] http://kff.org/interactive/subsidy-calculator/#state=ca&zip=...
[2] Note: the out-of-pocket will be somewhat higher because of the OOP maximum is in 2010 dollars.