Just over one quarter (26%) of all Americans of working age in 2011 experienced a gap in health insurance cover, says a new report published by the Commonwealth Fund. The authors explained that in many cases, when people change their jobs or become unemployed, many of them lose health coverage.

It can be extremely difficult to recover employer-sponsored health coverage after it is lost, the report showed. 69% of those who spent time with no health insurance, did so for at least 12 months; for 57% the period was longer than two years.

The data, which is based on the 2011 Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, showed that among those who had no insurance when the survey took place, 41% reported having had employer-sponsored coverage. 67% of individuals who lost their employer-sponsored coverage said the main reason for their loss of coverage was a loss or change of employment.

Many cannot find affordable insurance coverage on their own

The report, entitled "Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help", explained that purchasing coverage on their own is either not an option, or extremely hard for a large number of people of working age.

The authors found that:
  • 62% of individuals who attempted to purchase individual health insurance during the past 36 months found it either extremely hard or impossible to find affordable policies

  • 31% applied for health insurance coverage and were turned down, charged a higher price, or excluded because of some pre-existing condition

  • 60% of those who attempted to buy a plan on their own reported that it had been very or somewhat difficult to properly compare the benefits offered by different plans

  • 45% said they did not purchase a plan, the main reason being the high costs involved
Lead author, Sara Collins, Commonwealth Fund Vice President, said:

"For people who lose employer-sponsored coverage, the individual market is often the only alternative, but it is a confusing and largely unaffordable option. As a result, people are going a year, two years, or more without health care coverage, and as a result going without needed care."

Long insurance gaps associated with lower screening and preventive care rates

92% of those of working age who had continuous health insurance coverage said they had a regular doctor, compared to 76% among those with a coverage gap of up to 12 months, and 46% for those with longer coverage gaps.

Preventive cancer screening rates were much lower among those with coverage gaps, compared to insured people; the differences became larger the longer individuals had no health insurance.

Cholesterol checks - 70% of people with continuous insurance had had their cholesterol checked during the previous five years, versus 50% among individuals with a coverage gap of less than 12 months, and 33% for those with longer coverage gap periods.

Mammograms - 74% of women of working age with insurance had received a mammogram during the previous 24 months, versus just 28% among those with a coverage gap of at least 12 months.

Blood pressure - 83% of those with continuous health insurance had had their blood pressure checked during the previous 12 months, compared to 70% among individuals with a coverage gap of less than 12 months, and 51% for those with longer coverage gaps.

Authors say the Affordable Care Act is having an impact

The authors explain that the Affordable Care Act is already closing the large difference in the USA between the "haves" and the "have nots" regarding healthcare coverage. An example is the provision for dependent coverage that was introduced in 2010 - offspring up to the age of 26 years became eligible to remain on their parents' health insurance plan.

46% of 19 to 25 year-olds reported staying or joining their parents' insurance policy over the last 12 months. 23% of adults with children under 26 said they had an adult offspring remain on or enroll in their health plan.

However, the authors stressed that higher-income families appear to have taken advantage by this new option in much higher numbers than low-income ones. Probably because better-off families are more likely to already have health insurance, which can then be extended to their adult children.

Karen Davis, Commonwealth Fund President, said:

"The current system of health insurance in the United States has gaping holes, the effects of which have become increasingly pronounced during a weak economy. The Affordable Care Act is beginning to close those gaps, so that people who are already struggling can maintain health care coverage that will provide for their families' health and help ensure their financial security."

Written by Christian Nordqvist