Affordable Care Act Reforms Could Reduce The Number Of Underinsured US Adults By 70 Percent

Abstract

To provide a baseline and assess the potential of changes brought about under the Affordable Care Act, this study estimates the number of US adults who were underinsured or uninsured in 2010. Beginning in 2014, the Affordable Care Act of 2010 will provide income-related premium assistance and cost-sharing provisions to increase health care access and provide financial protection for people with lower incomes. These provisions will reduce exposure to out-of-pocket expenses for covered benefits. The law will vary cost-sharing standards as well as premium credits by poverty level in order to limit a person's risk of incurring high out-of-pocket expenses and to make care more affordable. The reforms thus seek to expand coverage and to reduce the number of insured people who are "underinsured" based on exposure to medical care costs that are high relative to their incomes.To provide a baseline as of 2010 and to examine the potential of the reforms, we used findings from a recent survey to estimate the number of adults who were underinsured or uninsured in 2010. The analysis updates 2003 and 2007 surveys using the same methodology to identify those who are underinsured. 3 We found a significant increase in the percentage who were underinsured from 2007 to 2010, although the change was less than that observed from 2003 to 2007. This probably reflects the slowdown in health spending as people cut back because of the recession. Including for the first time responses from people reached on their cell phones, the 2010 estimate provides a new baseline and target as the Affordable Care Act reforms unfold. To assess the reforms' potential, the study examined the risk of being underinsured or uninsured by poverty groups who will receive cost-sharing and premium assistance.

Prevalence and Predictors of Underinsurance Among Low-Income Adults

“…3 We followed previous research, which defines individuals as underinsured if they meet any one of the following criteria: out-of-pocket expenditures greater than 10 % of household income or 5 % of household income for those with incomes below 200 % of FPL (our entire sample has income below 125 % FPL); self-reported delays or failure to obtain necessary prescription medication due to cost; or selfreported delays or failure to receive necessary medical care or treatment due to cost. 2,5,[17][18][19] Individuals reporting no income were included in our primary analysis, but sensitivity analyses were conducted in which they were excluded to determine the effect on our estimates, since any out-of-pocket spending by these individuals would classify them as underinsured.…”

“…Underinsurance, or having insurance that does not adequately meet an individual's needs, is a significant problem, affecting an estimated 25 million adults in the U.S. 2 Evidence suggests that underinsurance has similar adverse effects on health care utilization and health outcomes as lacking insurance. 2 Underinsurance among adults has primarily been studied in middle-income individuals and those with private coverage.…”

“…2 Underinsurance among adults has primarily been studied in middle-income individuals and those with private coverage. [3][4][5] Increasing coverage for adults through Medicaid expansions is thought to be a way of improving adequacy of coverage.…”

“…[3][4][5] Increasing coverage for adults through Medicaid expansions is thought to be a way of improving adequacy of coverage. 2 However, considerably less attention has been paid to underinsurance among low-income adults, 2,[5][6][7] especially those with public insurance. While underinsurance has been examined among children in public programs, 8 previous research has not explored the possibility that adults in Medicaid might be underinsured.…”

The Impact of Financial Barriers on Access to Care, Quality of Care and Vascular Morbidity Among Patients with Diabetes and Coronary Heart Disease

“…In 2010, an estimated 29 million Americans were underinsured. 3 With the implementation of the Patient Protection and Affordable Care Act in 2014, the numbers of uninsured and underinsured Americans will decline, but millions of Americans will still be faced with significant financial barriers to care. 4 Multiple effects of uninsurance on health care have been reported and include impaired access to preventive services, 5 failure to diagnose chronic disease, 6 poor control of chronic conditions including hypertension, diabetes and hypercholesterolemia, 6 cost-related medication underuse 7 and increased mortality.…”