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Article added or updated:
02/03/2008 |
Gaps in Health Insurance: An All-American Problem
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OverviewGaps 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.
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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
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| 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 Health
Insurance 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. |
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. |
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