On the front page of its Business section, the San Francisco Chronicle (6/10, D1, Colliver) reported that the “number of adults nationwide who have health insurance, but face financial risk due to high out-of-pocket expenses — known as the underinsured — increased 60 percent between 2003 and 2007 to more than 25 million,” according to a survey published online in the journal Health Affairs. The data showed that “[m]iddle- and higher-income families, those with annual incomes of at least $40,000, experienced the sharpest increase among the uninsured, nearly tripling from four percent in 2003, to 11 percent in 2007.”
Investigators at the Commonwealth Fund, a non-profit group, surveyed “3,501 adults…from June 6 through Oct. 24, 2007,” the St. Louis Post Dispatch/Bloomberg (6/11, Marcus) adds.
Overall, the survey revealed that a “total of 75 million working adults were either uninsured or underinsured in 2007,” the Christian Science Monitor (6/11, Marks) notes. The authors pointed out that “underinsured Americans are now acting more like the nation’s 47 million uninsured.” According to Cathy Schoen, of the Commonwealth Fund, “This erosion in insurance protection is putting patients, families, and the nation’s health and economic security at risk.”
In the Wall Street Journal’s (6/10) Health Blog, Sarah Rubenstein wrote the data also showed that about “51 percent of the uninsured who were surveyed said they had problems paying medical bills, changed their way of life to do so, or were contacted by a collection agency. The figure was 45 percent for the underinsured.”
Health Day (6/10, Reinberg) added that “53 percent of the underinsured and 68 percent of those without health insurance had to forgo needed medical care, such as not seeing a doctor when sick, not filling prescriptions, and not getting recommended diagnostic tests or treatments,” according to the findings. Moreover, “underinsured people were more likely to have insurance plans that limit payments,” and “were also more likely to have high deductibles.” For instance, “one quarter of underinsured people had deductibles of $1,000 or more.”
Tuesday, June 10, 2008
The number of adults nationwide who have health insurance but face financial risk due to high out-of-pocket expenses – known as the underinsured – increased 60 percent between 2003 and 2007 to more than 25 million, a study released today found.
Middle- and higher-income families, those with annual incomes of at least $40,000, experienced the sharpest increase among the uninsured, nearly tripling from 4 percent in 2003 to 11 percent in 2007, according to the study by the Commonwealth Fund, which was published online in the journal Health Affairs.
While an estimated 47 million Americans have no insurance at all, health experts say people who are required to pay high deductibles and co-payments for limited benefits often go without care due to costs.
“Lack of insurance is only one part of the problem as even the insured have serious gaps in coverage,” said Karen Davis, president of the Commonwealth Fund, a private fund that supports independent health research. “Insurance coverage is the ticket into the health care system but, for too many, that ticket does not provide genuine access to care.”
The study based its data on a survey of about 3,500 adults conducted from June to October 2007. About three quarters of the respondents were between the ages of 19 and 64 years old, meaning most were working adults who were not yet eligible for the federal Medicare program.
Those defined as underinsured had health insurance all year but had out-of-pocket medical expenses of at least 10 percent of their income, or 5 percent for those with low incomes.
The report’s authors said people with individual or small-group coverage, typically those who worked for a small business or were self-employed, were more likely to have insurance that required substantial cost sharing than those with coverage through large employers.
Forty-five percent of the underinsured reported difficulties paying their medical bills, being contacted by collection agencies for unpaid bills or changing their way of life to cover their health expenses.
“Here in the United States, you can have health insurance all year long and still go into medical debt or face bankruptcy,” said Cathy Schoen, senior vice president of the Commonwealth Fund and lead author of the report.
A 61-year-old San Mateo County woman, who declined to be identified out of fear that she could lose her policy, said she’s incurred $35,000 in out-of-pocket medical expenses in the last six years despite never having a gap in health insurance.
“I’ve put stuff on credit cards up to my elbow,” she said. She and her husband changed their lifestyle to afford their share of medical costs, but have not had to file for bankruptcy.
Some of her uncovered expenses include $5,000 for her share of three MRIs conducted in January 2007 for a back injury and a recent $1,750 bill for three injections that were not covered by her Anthem Blue Cross small-group business policy. The policy costs $1,000 a month for her and her husband along with a $5,000 annual deductible.
“The rates keep going up, but they keep cutting services,” she said, noting that she still feels fortunate to have health insurance.
To read the report, go to commonwealthfund.org or healthaffairs.org.
Insured, but vulnerable
A study released today by the Commonwealth Fund found that people who had health insurance all year but were required to pay high out-of-pocket expenses experienced some of the same problems as those with no health insurance at all. According to the study:
— About 68 percent of the uninsured and 53 percent of the underinsured said they went without needed care because of cost, compared with 31 percent of those with adequate insurance.
— Nearly half – 45 percent – of the underinsured reported financial stress due to medical bills. About 51 percent of the uninsured and 21 percent of those with better coverage said they experienced similar financial difficulties.
Source: Commonwealth Fund
E-mail Victoria Colliver at vcolliver@sfchronicle.com.
Ranks of Underinsured Are Rising, Study Finds
Published: June 10, 2008
The number of people in this country who have health insurance but not the ability to afford adequate medical care continues to climb.
About 25 million Americans — or approximately one of every five adults younger than age 65 with health insurance — did not have sufficient coverage last year to shield them from financial hardship if they ended up in the emergency room or were seriously ill, according to a new study to be released on Tuesday by the Commonwealth Fund.
“We’re moving in a direction where you can be insured all year and still face medical bankruptcy,” said Cathy Schoen, the study’s lead author and a senior vice president for research and evaluation at the Commonwealth Fund, a private foundation in New York specializing in health research.
The relentless rise in the cost of medical care, combined with a growing number of insurance plans that require patients to pay a higher portion of their medical bills has led to a 60 percent increase in the number of underinsured adults from 2003 to 2007, according to the study. The Commonwealth Fund first calculated the number of underinsured in 2003 when it estimated that 16 million Americans did not have sufficient coverage.
As the nation debates how best to improve its health care system, including how to insure the increasing number of Americans without coverage, policy makers also need to discuss the quality of available coverage, said Karen Davis, the president of the Commonwealth Fund.
“Lack of insurance is only part of the problem, as even the insured have serious gaps in coverage,” she said.
The study, to be published by the medical policy journal Health Affairs, also indicates that the sharpest increase in the underinsured were middle-class families whose coverage still left them vulnerable to medical costs equal to 10 percent more of their incomes. While coverage offered by large companies remains fairly generous, people who try to buy individual policies or who are covered through small companies increasingly must settle for policies that require high deductibles or that sharply limit the benefits as way of reducing the size of the premiums.
Like the approximately 50 million uninsured Americans, the underinsured often choose to forgo necessary medical care, the study indicated. Twice as many people who are underinsured said they did not fill a drug prescription or see a recommended specialist for care, the survey found, compared with the number of people who had more generous coverage. They also tend not to get preventive care, choosing not to get mammograms or have their cholesterol checked.
“The underinsured look a lot like the uninsured,” Ms. Schoen said. “Disturbingly, even adults with chronic diseases, when underinsured are not filling their prescriptions.”
Some large companies are already alert to the need to offer health coverage in ways that do not discourage their employees from getting care they might need, she said.
Pitney Bowes, for example, has found it critical to make sure workers with chronic diseases like asthma or hypertension get the care they need help reduce the odds of their being hospitalized or developing complications that could otherwise be avoided, said Johnna Torsone, the company’s chief human resources officer. When Pitney Bowes reduced the amount of co-insurance for asthma medications, for example, it had a 15 percent drop in the annual average cost of care for the disease.
“If people are incented to manage those conditions appropriately, they can be more productive and our costs go down,” Ms. Torsone said.
The Commonwealth study also underscores the need to address the rising cost of health care, which is starting to leave even those in the middle class vulnerable to financial stress, said Len Nichols, a health economist who directs the health policy program for the New America Foundation, a nonprofit group that advocates universal health care.
“Cost is central,” he said. He noted that a national debate is already under way about how best to control medical expenses, through changes in the payment process and better information technology.
But as the states seek to improve the insurance market for individuals and small businesses, the Commonwealth study’s findings point to the need to also focus on the quality of coverage, Ms. Schoen said. In Massachusetts, for example, the state focused both on making sure that individuals had plans they could purchase and also that the plans provided sufficient coverage.
“They’ve both lowered the rates of the uninsured and lowered the rates of the underinsured,” Ms. Schoen said.
The fund’s estimate is based on a survey conducted last year of adults under 65 years old who had insurance throughout the year. Individuals were considered underinsured if their out-of-pocket medical expenses were 10 percent of their income, or 5 percent if they were low-income adults or had insurance deductibles that exceeded 5 percent of their incomes.
