A recent commentary in the Commonwealth Fund provided excellent insight to the plight of the underinsured. . . such as the fact that as of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 % from 2003. This is why base coverage requirements are needed on a national scale to reduce the erosion of coverage that is generated by high deductible and co-pay plans. Here are some thoughts along with link to expanded article with citations . . . jomaxx

 

What is an underinsured adult?

Persons whose health coverage does not adequately protect them from high medical expenses.

How many are there?

As of 2007, it is estimated that there are 25 million underinsured adults in the United States, up 60 percent from 2003.  This increase is predominantly among the middle class.

How fast is this group growing?

Adults with incomes above 200 percent of the federal poverty level (about $40,000 per year for a family), saw the number of underinsured nearly triple since 2003.

How do you identify a person as underinsured?

If they spent 10 percent of more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses, or if they had deductibles that equaled 5 percent or more of their income.

How many are underinsured?

14 % of all nonelderly adults were underinsured in 2007, and more than 25 % were uninsured for all or part of the year.

How do the underinsured add to the overall health insurance problem?

If you add these two together (no insurance and underinsured), 75 million adults—42 percent of the under-65 population—were effected in 2007, a 35 % increase since 2003.

Who is at risk for being underinsured?

Those with incomes below the poverty level were at highest risk of being uninsured or underinsured, but this problem has now advanced well into the middle class.

Among those with annual incomes of $40,000 – $59,000, the underinsured percentage rate reached double digits in 2007.

What is the effect of underinsurance?

The underinsured report access and financial stress issue similar to those with no insurance at all.

53% of those underinsured and 68% of those without insurance went without necessary medical attention, such as not seeing a doctor when sick, not filling prescriptions, and not following up on tests or treatment.  31 percent of insured adults went without such care.

45% of the underinsured and 51% of the non insured reported difficulty paying bills, being contacted by collection agencies for unpaid bills, or changing their way of life to pay medical bills. Many  had to take out a loan, mortgage their home, or use credit card debt to pay their bills.  Only 21 % of insured adults reported financial stress related to medical bills.

Why the increase in underinsured adults?

This is due in part, to changes in design of insurance benefits that leave individuals financially vulnerable.

Underinsured adults reported benefit limits more often than those with adequate coverage.

The underinsured also had high deductibles with 25 % having an annual per-person deductibles of $1,000 or greater.

Despite these limits and higher deductibles, underinsured adults reported high annual premium costs that are comparable to those reported by more adequately insured people.

Individuals that have policies with substantial cost-sharing compared to their income can undermine access to care and erode family finances.

What are the lessons for real health insurance reform?

It is important to consider cost-sharing provisions, benefits, and income when exploring coverage mandates.

Health insurance reform in Massachusetts has graduated cost-sharing and premium assistance for those with incomes up to 300 % of the poverty level.

Citation

C. Schoen, S. R. Collins, J. L. Kriss, M. M. Doty, How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, The Commonwealth Fund, June 2008