Gaps in health insurance: An all-American problem
Overview
Watch
a
multimedia presentation about the findings, with audio and
slides, by lead author Sara R. Collins, Ph.D., senior program
officer and director of the Fund's Program on the Future of Health
Insurance.
Gaps in health insurance coverage—a problem that has long
afflicted lower-income U.S. families—is increasingly becoming an
all-American problem. Findings from the Commonwealth Fund Biennial
Health Insurance Survey show that, while lack of insurance continues
to be highest among families with incomes under $20,000, uninsured
rates for moderate- and middle-income earners and their families are
rising, putting their health and financial security at risk.
The
survey finds that most of these individuals reside in working
families: Of the estimated 48 million American adults who spent any
time uninsured in the past year, 67 percent were in families where
at least one person was working full time. In addition, survey
respondents were asked about problems with medical bills and accrued
medical debt; difficulties in accessing needed health care; problems
managing chronic conditions; utilization of routine preventive care,
like mammograms and colonoscopies; and coordination and efficiency
of care.
Executive Summary
National health care spending is climbing by more than 7
percent per year, outpacing economic growth by a substantial margin.
As health care costs have climbed, so has the number of people
without health insurance in the United States, even during a period
of overall economic growth. In 2004, according to U.S. Census data,
nearly 46 million people of all ages were uninsured, an increase of
6 million over 2000. This combination of eroding health insurance
coverage and rapidly rising health care costs raises concerns about
the ability of U.S. families to obtain timely medical care, protect
their finances from catastrophic health care costs, and save for
retirement.
The Commonwealth Fund Biennial Health Insurance Survey, a
nationally representative survey of 4,350 adults age 19 and older,
presents new information on the health insurance coverage of
Americans and the health and financial consequences families face
when they experience breaks in insurance. The survey, conducted
between August 2005 and January 2006, finds that while the
lowest-income families have always been most at risk of not having
insurance coverage, more moderate- and middle-income earners and
their families are also in jeopardy. In addition, one of five of all
adults under age 65 is currently paying off debt from medical bills
incurred in the past. Those who lack insurance are particularly
affected by this burden. The survey also finds that uninsured people
with chronic health conditions like diabetes and asthma are much
more likely to skip medications for their conditions and go to an
emergency room or hospital than are those who are insured.
Key findings of the survey include:
Rising
Numbers of Uninsured Individuals Are in Moderate- and Middle-Income
American Families
Two of five (41%) working-age Americans with incomes between
$20,000 and $40,000 a year were uninsured for at least part of the
past year—a dramatic and rapid increase from 2001 when just over
one-quarter (28%) of those with moderate incomes were uninsured
(Figure ES-1).
Adults with incomes under $20,000 were still the most likely
to be uninsured: more than half (53%) had spent time uninsured in
the past year.
Most people who are uninsured are in working families. Of the
estimated 48 million American adults who had any time uninsured in
the past year, 67 percent were in families where at least one person
was working full time.
Many
Americans Report Medical Bill Problems and Medical Debt
One-fifth (21%) of working-age adults, both insured and
uninsured, currently have medical debt they are paying off over time
and more than two of five (44%) of these individuals are carrying
$2,000 or more in debt.
More than one-third (34%) of adults ages 19 to 64 either had
medical bill problems in the past year or were paying off accrued
medical debt. Problems include not being able to pay bills, being
contacted by a collection agency about unpaid medical bills, or
having to change way of life to pay bills.
Three of five (62%) of all adults with medical bills or debt
problems said they or their family member were insured at the time
the debt was incurred.
More than half (51%) of uninsured adults reported medical
debt or bill problems. Of those, nearly half (49%) used up all their
savings to pay their bills. Two of five were unable to pay for basic
necessities like food, heat, or rent because of medical bills.
Rates of medical bill problems and debt were high among
people in both lower-income and higher-income households who
experienced a time uninsured. Indeed, rates were highest among those
with higher incomes. Nearly three of five (59%) adults with incomes
of $40,000 or more reported difficulties with medical bills or
accrued debt. Forty-six percent of adults with higher incomes were
paying off unpaid medical bills over time, with over half (54%) of
these individuals carrying $2,000 or more in medical debt.
People
with Gaps in Coverage Have Difficulty Managing Chronic Conditions
An alarmingly high proportion—59 percent—of uninsured adults
who had a chronic illness, such as diabetes or asthma, did not fill
a prescription or skipped their medications because they could not
afford them.
More than one-third (35%) of uninsured adults who had a
chronic condition went to an emergency room or stayed overnight in
the hospital in the past year because of their condition—about two
times the rate of people with chronic health problems who were
insured all year (Figure ES-2).
Individuals with Gaps in Coverage Are Much Less Likely to Get
Preventive Care
Only 18 percent of uninsured adults ages 50 to 64 had a colon
cancer screen in the past five years, compared with 56 percent of
adults insured all year.
Less than half (48%) of uninsured women ages 50 to 64 had a
mammogram in the past two years, compared with 75 percent of women
who were insured all year.
Few adults without medical insurance receive dental care:
only 35 percent of those uninsured at the time of the survey had a
dental exam in the past year, half the rate of those who were
insured for the full year.
People
with Gaps in Coverage Experience Inefficient Care
Nearly one-quarter (23%) of adults who reported spending any
time uninsured in the past year said test results or medical records
were not available at the time of a scheduled appointment, compared
with 15 percent of continuously insured adults.
Nearly one of five (19%) adults with any time uninsured said
he or she had been given a duplicate test, twice the rate of
duplication reported by continuously insured adults.
It is clear from the findings of this survey and from prior
research that the health care—and ultimately the health and
productivity—of the U.S. population is being damaged as the nation's
insurance problem continues to grow. Real solutions that build on
group forms of coverage already in place, including employer plans,
Medicare, Medicaid, the State Children's Health Insurance Program,
and state and federal employee benefits plans, will help to fill
insurance gaps with meaningful, affordable coverage that helps link
families and providers. Preventive care routines, like cancer
screenings, blood pressure and cholesterol tests, dental exams, as
well as care for chronic conditions, should be the shared reality of
all Americans.