How Many Are Underinsured? Trends Among U.S. Adults, 2003 And 2007

Abstract

With health insurance moving toward greater patient cost sharing, this study finds a sharp increase in the number of underinsured people. Based on indicators of cost exposure relative to income, as of 2007 an estimated twenty-five million insured people ages 19-64 were underinsured-a 60 percent increase since 2003. The rate of increase was steepest among those with incomes above 200 percent of poverty, where underinsurance rates nearly tripled. In total, 42 percent of U.S. adults were underinsured or uninsured. The underinsured report high levels of access problems and financial stress. The findings underscore the need for policy attention to benefit design, to assure care and affordability.

Prevalence and Predictors of Underinsurance Among Low-Income Adults

“…Our first major finding was a high rate of underinsurance (34.5 %) among adults living at less than 125 % FPL, even higher than rates estimated in prior research examining lowincome adults up to 200 % FPL. 21 This rate remained quite high even among those insured through Medicaid (26.0 %); to our knowledge, prior research has not examined the source of insurance among low-income underinsured adults. While Medicaid is often considered comprehensive coverage, our findings question this assumption for a marginalized population of low-income adults who reported substantial out-ofpocket medical expenditures.…”

“…These variables were chosen based on a conceptual framework derived from the Anderson and Aday model for health care access, 20 and prior research. 21 We then compared family income and out-of-pocket health care spending by underinsurance status, within each insurance category. Weighted means and designadjusted confidence intervals were computed and tested between groups using dummy variables in linear regression analyses.…”

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

“…To our knowledge, this is the first study to address the impact of financial barriers at multiple points along the continuum of care-from access to care to disease monitoring to screening for complications to medication compliance to outcomes in a high-risk population with multimorbidity. Given the growing numbers of Americans with financial barriers to care 18 and the increasing prevalence of diabetes, 19 these findings not only have important implications for public health, but should also inform the ongoing debate on health care reform. Financial barriers to health care effect a broad and growing population that includes both individuals with no health insurance and those with health insurance who experience financial hardship in paying for various components of health care.…”

State Variation in Underinsurance Among Children With Special Health Care Needs in the United States

“…For example, studies that have examined geographic variations in uninsurance (the total lack of comprehensive insurance) have found wide variations for both children and adults. [6][7][8] According to the US Census Bureau's 2007 Current Population Survey, the prevalence of uninsured children ranged from 4.1% to 21.2% across states. 8 A similar-sized range across states in the prevalence of underinsured children would not be surprising.…”