The number of adults whose health insurance was inadequate rose 80% from 2003 to 2010, according to a report by the Commonwealth Fund published in the journal Health Affairs. They added that the Affordable Care Act aims to bring down this number by 70%.

The Commonwealth Fund defines underinsured adults as those who say yes to at least one of the following:

  • Out-of-pocket family medical care spending makes up over 10% of income (not including premiums)
  • Medical expenses that represent over 5% of income (in families whose income is below 200% of federal poverty level)

In this study, the researchers gathered data from the Commonwealth Fund 2010 Health Insurance Survey, which included a telephone survey of 4,005 individuals aged 19+ years in mainland USA. People were asked about out-of-pocket expenditure, insurance, care experiences, health status, income, and other demographic characteristics.

The researchers found that:

  • In 2003 there were 16 million underinsured adults in the USA
  • In 2010 there were 29 million underinsured
  • 61 million adults were either underinsured or uninsured in 2003
  • 75 million adults were either underinsured or uninsured in 2007
  • 81 million adults were either underinsured or uninsured in 2010 – 44% of the country’s adult population
  • 77% of adults whose incomes were below 133% of the poverty level were either underinsured or uninsured in 2010
  • 58% of adults whose incomes were between 133% and 250% of the poverty level were either underinsured or uninsured 2010

The chances of being underinsured are progressively rising up the income ladder. 16% of adults earning between $40,000 and $60,000 each year were underinsured in 2010, while another 19% were uninsured, compared to only 5% of adults in that income range being underinsured in 2003.

Adults who are underinsured are twice as likely to forego medical care, and three times as likely if they are uninsured, compared to those with adequate medical cover. To forego medical care means, for example, not fill a prescription, or not follow up on recommended tests or treatment.

If the Affordable Care Act achieves what it has been set up to do, and reaches adults with lower incomes, there should be a 70% reduction in the number of underinsured adults in the country, once the whole law is put into practice.

The authors say that the ever-growing problem of underinsurance for the working-age population, together with extremely modest gains in net disposable incomes over the last ten years, has put insured as well as uninsured families’ health at risk, as well as their financial security.

They add that the Affordable Care Act can address these risks and really help families. However, it depends on the success of several factors, such as the choice of insurance plans offered through the health insurance exchanges, and how much health care costs rise in relation to wages.

The authors wrote:

“Designs will need to take a value-based approach that ensures access and financial protection for essential care.”

Written by Christian Nordqvist