Nearly half of all working age adults in the United States — or 84 million people — went without health insurance for a time last year, or had out-of-pocket costs that were so high relative to their income they were considered underinsured, according to the Commonwealth Fund 2012 Biennial Health Insurance Survey.
But the percentage of young adults ages 19 to 25 who were uninsured during the year fell from 48 percent to 41 between 2010 and 2012, a departure from the nearly decade-long trend of rising uninsured rates in that age group. This reversal is likely due to the 2010 ACA provision allowing young adults to stay on their parents’ health insurance until age 26, the study’s authors say.
The report, Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act, finds that 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 say that this is partly a result of slower healthcare cost growth and lower overall health spending by consumers, combined with declining household incomes. But 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.
Key findings from the report:
- In 2012, 80 million people reported that, during the past year, they did not go to the doctor when they were 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.
- Also in 2012, 41 percent 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 of five — 18 percent — of adults were contacted by a collections agency over unpaid bills, and 16 percent had to change their way of life because of medical bills. Thirty two million people said their credit ratings were lowered, and about 4 million had to declare bankruptcy because of medical debt.
The health reform law has already helped millions of young adults gain insurance coverage and protected people from insurance company practices like cancelling policies retroactively when a subscriber becomes sick, or putting a limit on how much they will pay out in a given year or lifetime. 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 impact Americans currently uninsured or underinsured, the report finds that:
- Eighty-seven percent 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 law, though coverage is limited to those legally present in the United States.
- Up to 85 percent 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 say it is critical that the federal government and the states continue to implement the ACA, cautioning that if states don’t 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 in 2014.
Additional report findings include the following:
- In 2012, about three-fourths of working-age adults with low incomes (less than $14,856 a year for an individual or $30,657 for a family of four)— an estimated 40 million people — were uninsured or underinsured.
- Fifty-nine percent of adults with moderate incomes (between $14,856 and $27,925 for an individual or between $30,657 and $57,625 for a family of four) — or 21 million people — were uninsured or underinsured.
Adults who were uninsured were less likely to receive recommended preventive care in 2012. For example, only 48 percent of women who were uninsured during the year received a mammogram within the recommended period, compared to 77 percent of those who were well insured all year.
The Commonwealth Fund Biennial Health Insurance Survey was conducted by Princeton Survey Research Associates International from April 26 to August 19, 2012. The survey consisted of 25-minute telephone interviews in either English or Spanish and was conducted among a random, nationally representative sample of 4,432 adults ages 19 and older living in the continental United States. The sample was drawn from a combination of landline and cell phone random-digit dial (RDD) samples.
Source: The Commonwealth Fund , April 26, 2013
Healthcare Trends & Forecasts in 2013: A Strategic Planning Session features Steven Valentine, president, The Camden Group, Hank Osowski, managing director of Strategic Health Group and Dennis Eder, also a managing director at Strategic Health Group, giving a look ahead to help shape strategic plans.