Insured But Not Protected: How Many Adults Are Underinsured?

Abstract

Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19-64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35 percent (sixtyone million) were under-or uninsured. These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage.T h e r e le n t le s s r i s e i n h e a lt h c a r e c o s ts and insurance premiums has spurred a move away from more-comprehensive insurance benefits for the population under age sixty-five. Trends instead point toward plans with higher deductibles, patient cost sharing, and, in some instances, a more restricted scope of benefits. Faced with the fourth consecutive year of double-digit premium inflation and the demise of managed care options, employers have sought to moderate their premium costs by offering new insurance products that shift more financial risk to workers.1 Insurance plans sold to small businesses, in particular, have moved to sharply higher deductibles; however, increases are also spreading across larger firms. 2Recent federal policies have also pushed toward higher patient cost sharing through enactment of new tax-protected health savings accounts (HSAs) available only to people with insurance policies having deductibles of at least $1,000 per person. Some proposals would further encourage such high-deductible plans. 3Although the United States already stands out among industrialized countries for the high share of medical costs its citizens pay out of pocket, trends point to still greater patient and family exposure to medical care costs in the future, reversing T h e U n d e r i n s u r e d H E

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.…”

“…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. 2 However, considerably less attention has been paid to underinsurance among low-income adults, 2,[5][6][7] especially those with public insurance.…”

“…[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.…”

Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007

“…An estimated one-third of U.S. adults are either uninsured during the year or underinsured. 5 Among the countries, the United States has the smallest share of general practice (GP)/family practice (FP) physicians and relies extensively on internal medicine and pediatrics for primary care. However, even in the other coun- tries, the percentage of primary care physicians has been declining.…”

Church-Based Heart Health Project: Health Status of Urban African Americans

“…The number of uninsured Americans continues to grow, and the number of underinsured Americans may be growing even faster as high-deductible health plans increase in number. 20 Too many of the purely uninsured people do not vote, so it's far too easy for elected officials not to hear their voices. Underinsured Americans, however-people who are insured but face out-of-pocket costs that are high relative to their incomes 20 -can create a major new political backlash because underinsured people tend to be fully employed people, 20 who are more likely to vote.…”