The number of Americans that have medical insurance but are poorly covered rose by 60 per cent in the last 4 years to reach 25 million, leaving many without needed care and facing medical debt, according to a new study.
The study, published yesterday, Tuesday 10th June, is titled How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, and was conducted by the The Commonwealth Fund, an independent health reform foundation based in New York.
“Premiums are up but people are buying less protection,” said Cathy Schoen, lead author and Commonwealth Fund Senior Vice President.
Schoen and her co-authors, Sara Collins, Jennifer Kriss and Michelle Doty, defined the underinsured as those people who had health insurance all year, but whose medical expenses relative to their income was high.
They used a threshold figure of 10 per cent or more of income being spent on out of pocket medical expenses, or 5 per cent of income for those families on low income. (Low income was defined as under 200 per cent of federal poverty line.)
On this basis, the study found that between 2003 and 2007 the total of underinsured adults in the US rose from 16 to more than 25 million, a 60 per cent increase.
The sharpest rise was among middle and higher income families, where the number of underinsured has tripled between 2003 and 2007. This group includes those families whose incomes are 200 per cent or more above the federal poverty line, equivalent to an annual income of 40,000 dollars or more.
Schoen and colleagues estimated the number of uninsured adults using data from The Commonwealth Fund 2007 Biennial Health Insurance Survey, updating a 2003 study. The survey was carried out by Princeton Survey Research Associates International, who between June and October 207, interviewed a nationally represented sample of 3,501 adults living in the continental United States, including 2,616 adults aged 19-64.
Comparing out-of-pocket health care costs relative to income, Schoen and colleagues found that 25.2 million adults aged 19 to 64 were insured, but their insurance was not enough.
Among middle income families, those with incomes lying in the range 200 to 400 per cent above the federal poverty line, the rates of underinsurance have now reached “double digit levels” said the authors.
Schoen said:
“We are seeing the sharp increase in the underinsured because the insured are facing higher cost-shares and limits in insurance benefits.”
“Today you can have health insurance and still go bankrupt if you get sick. This puts individuals, families, and the nation’s health and economic security at risk,” she added.
Schoen and colleagues estimated that 42 per cent of adults in the 19 to 64 age range, or 75 million people, were either uninsured or underinsured in 2007. This is up by one third from 2003.
The authors found that the underinsured experienced similar difficulties to the uninsured: they were both significantly more likely to go without the health care they needed, and they struggled to pay medical bills, compared to people with adequate health insurance. The figures showed that:
- 53 per cent of underinsured and 68 per cent of uninsured people did not get needed care because of cost.
- This included: not seeing a doctor when sick, not filling prescriptions, not going for recommended diagnostic tests or treatments.
- This compared with 31 per cent of insured people going without such care.
- The underinsured were almost as likely as the uninsured to experience financial stress in the cost of medical bills.
- 45 per cent of the underinsured, and 51 per cent of the uninsured said they had difficulty paying bills, were contacted by collection agencies for unpaid bills, or changed their way of life in order to pay their medical bills.
- This compared to 21 per cent of the insured people saying the same.
The authors also found that compared to adults with adequate insurance, the underinsured were more likely to have plans that had limits on the amount they paid out or on visits, and they were more likely to have high deductibles (25 per cent had annual deductibles of 1,000 dollars or more).
And, although the underinsured had these limited benefits, they were paying similar premiums to those with adequate insurance. These premiums were often very high compared to income, which created more financial stress.
The authors concluded that:
“Benefit designs that reduce cost-sharing for high-value, cost-effective care and lower cost-sharing for families with low and modest incomes will be necessary to achieve quality care and better health outcomes rather than just coverage.”
Commonwealth Fund President Karen Davis, said, “Shifting costs to patients is not an equitable or effective solution to rising costs. Middle and low income families are struggling through tough economic times and we need to extend affordable, effective health insurance to all.”
“The United States needs to move in new directions,” she added, urging:
“It’s time for serious consideration of changes in the way we pay for and deliver health services — reforms that show much greater potential for gains in quality and efficiency.”
“How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007.”
C. Schoen, S. R. Collins, J. L. Kriss, M. M. Doty.
The Commonwealth Fund, June 2008.
Source: Commonwealth Fund.
Written by: Catharine Paddock, PhD