In 2012, close to 84 million people – half of all working-age U.S. adults did not have health insurance at one point, or had extra out-of-pocket expenses that were so high relative to their pay, they were actually considered underinsured, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey.

The survey also revealed that the sample of young adults aged 19-25 who were uninsured during the year dropped from 48% to 41% between 2010 and 2012 – reversing a trend of climbing uninsured rates in that age group.

The reversal of this trend is due to the implementation of the 2010 Affordable Care Act that permitted young adults to stay on their parents’ insurance plans until the age of 26, according to the authors.

The report found that the percentage of Americans who were underinsured or uninsured, or had gaps in their health coverage rose between 2003 and 2010, while the number of underinsured doubled from 16 million in 2003 to 29 million in 2010. Later, underinsured adults leveled off at 30 million between 2010 and 2012.

Changes in the healthcare law reform, such as requiring insurers to cover preventive care without any cost to patients are starting to make healthcare affordable to a wider audience.

The survey suggests that many people live without insurance because they simply cannot afford it. Eighty million people documented that in 2012 they chose not to go to the doctor when they were sick or did not get a prescription filled because of expenses. The rates of those skipping care increased significantly from 2003, when 63 million did not get care because of costs.

Medical debt is another danger that still affects U.S. citizens. In 2012, 41% of working-age adults had issues paying their medical bills or were paying off medical bills gradually.

The report found that medical debt significantly impacted people’s lives:

  • Close to 18% of adults have been contacted by a collection agency because of overdue bills
  • 32 million people had a lower credit rating due to medical bills
  • Nearly 6% of people had to declare bankruptcy because of medical bills

Under the law changes, millions of young Americans now have access to insurance and many others are protected from company practices like canceling a policy once a person becomes ill or lifetime or year limits on payouts.

A report released last year proved that the Affordable Care Act helped Medicare recipients save millions on prescriptions.

However, the majority of the law’s effects will not take place until 2014 when the remaining reforms take action and new insurance marketplaces are in business.

Using the report as a basis, the new parts of the Affordable Care Act will impact underinsured or uninsured Americans in the following ways:

  • Of the 55 million people who were uninsured in 2012, 87% of them have incomes that qualify them subsidized health insurance through the insurance marketplaces or expanded Medicaid.
  • Close to 85% of the 30 million underinsured adults may qualify for Medicaid or subsidized health insurance plans with decreased out-of-pocket expenses under the law

The authors emphasize that state and federal governments need to continue to implement the changes to the law or millions of low-risk families will be at risk for being uninsured even after the law takes effect in 2014.

A separate study done last year by Vanderbilt University suggested that states who choose not to expand their medicaid programs under the Affordable Care Act will actually cost the hospitals. The refusals could result in unintentional cuts for hospitals that provide uncompensated care.

Commonwealth Fund president David Blumenthal, M.D said:

“The costs of health care and health coverage in the United States have been on an unsustainable trajectory, straining family and government budgets. It is important that lawmakers and regulators across the country take the steps necessary to ensure that all Americans can benefit fully from the law’s improvements to the quality, efficiency, and affordability of our health care system.”

  • About three-fourths of working-age adults with low-incomes (under $14,856 per year for one person) – i.e. 40 million people, were underinsured or uninsured.
  • Fifty-nine percent of adults with moderate incomes (between $14,856 and $27,925 per year for one person) – i.e. 21 million people were underinsured or uninsured.
  • Uninsured adults were less likely to receive recommended preventive care in 2012.

Written by Kelly Fitzgerald