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Report: Tens of millions lack sufficient insurance

Friday April 26, 2013
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About 84 million people, representing nearly half of all working-age U.S. adults, went without health insurance for a time last year or were considered underinsured due to high out-of-pocket costs relative to income, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey.

The proportion of young adults ages 19 to 25 who were uninsured during the year fell from 48% to 41% between 2010 and 2012, reversing a nearly decade-long trend of rising uninsured rates in that age group.

This reversal likely is due to a provision in the 2010 Affordable Care Act allowing young adults to stay on their parents’ health insurance until age 26, the authors said.

According to the report, "Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act," the percentage of Americans who were uninsured, underinsured or had gaps in their health coverage grew steadily between 2003 and 2010, with the number of underinsured nearly doubling from 16 million in 2003 to 29 million in 2010.

However, between 2010 and 2012, the numbers of underinsured adults leveled off, growing to 30 million. The authors said this trend partly is a result of slower healthcare cost growth and lower overall health spending by consumers, combined with declining household incomes. Provisions in the health reform law, such as requiring insurers to cover recommended preventive care without any cost to patients, also are beginning to make healthcare more affordable for many consumers.

"The early provisions of the Affordable Care Act are helping young adults gain coverage and improving the affordability of healthcare during difficult economic times for American families," Sara Collins, PhD, a Commonwealth Fund vice president and the study’s lead author, said in a news release. "It will be critical to continue to monitor the effects of the law as the major provisions go into effect in 2014 and beyond to ensure it achieves its goal of near-universal, comprehensive health insurance."

According to the survey, people increasingly are skipping needed healthcare because they cannot afford it. In 2012, 80 million people reported that during the past year, they did not go to the doctor when sick or did not fill a prescription due to cost. Reports of skipping needed care rose substantially from 2003, when 63 million people did not get care because of cost.

Medical debt also continues to burden U.S. households. According to the report, in 2012, 41% of working-age adults, or 75 million people, had problems paying their medical bills or were paying off medical bills over time, up from 58 million in 2005. Nearly one in five adults (18%) were contacted by a collections agency over unpaid bills, and 16% had to change their way of life because of medical bills.

Medical debt has substantial consequences, according to the report: 42% of survey respondents who reported having trouble with medical bills, or an estimated 32 million people, had a lower credit rating because of unpaid bills; and 6%, or an estimated 4 million, had to declare bankruptcy because of their bills.

Impact of the Affordable Care Act

The health reform law already has helped millions of young adults gain insurance coverage and protected people from insurance company practices such as canceling policies retroactively when a subscriber becomes sick or putting a limit on how much they will pay out in a given year or lifetime, according to the report. But the bulk of the law’s effects will not be felt until 2014, when the health insurance reforms are fully implemented and the new state insurance marketplaces are up and running.

Using the survey findings to determine how the ACA will affect Americans who are uninsured or underinsured, the report states:

• 87% of the 55 million people who were uninsured for some time during the year in 2012 have incomes that would make them eligible for subsidized health insurance through the insurance marketplaces or expanded Medicaid under the ACA, although coverage is limited to those legally present in the U.S.

• Up to 85% of the 30 million underinsured adults might be eligible for either Medicaid or subsidized health insurance plans with reduced out-of-pocket costs under the law.

The authors said the federal government and the states must continue to implement the ACA, cautioning that if states do not expand Medicaid as the law originally intended, millions of low-income families will be at risk for being uninsured even after the law takes full effect.

"The costs of healthcare and health coverage in the United States have been on an unsustainable trajectory, straining family and government budgets," said Commonwealth Fund president David Blumenthal, MD. "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 healthcare system."

Read the report: www.commonwealthfund.org/Publications/Fund-Reports/2013/Apr/Insuring-the-Future.aspx.


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