New Health Affairs study finds underinsured adults skip needed care and struggle with medical debt; Affordable Care Act reforms could substantially reduce the number of underinsured
The number of underinsured adults-those with health insurance all year, but also with very high medical expenses relative to their incomes-rose by 80 percent between 2003-2010, from 16 million to 29 million, according to a new Commonwealth Fund study published in the September issue of Health Affairs. Nearly half (44%) of U.S. adults-81 million people-were either underinsured or uninsured in 2010, up from 75 million in 2007 and 61 million in 2003.
The study finds that in addition to covering the uninsured, Affordable Care Act (ACA) reforms will also provide significant relief for those who are underinsured, potentially reducing their numbers by as much as 70 percent once the law is fully implemented.
"Underinsured families are at nearly as high risk as the uninsured because, while they have health insurance, holes or limits in their plans expose them to often unaffordable medical costs," said lead study author and Commonwealth Fund Senior Vice President Cathy Schoen. "To reduce the number of underinsured, it will be critical for the plans offered under the Affordable Care Act reforms to keep deductibles and out-of-pocket costs low for essential, effective health care."
Although insured all year, underinsured adults reported high rates of access concerns and financial stress. The study finds that the underinsured go without needed health care and struggle to pay medical bills or medical debt at rates at times similar to those without health insurance. Nearly half (46%) of underinsured and 63 percent of uninsured adults didn't fill a prescription, see a doctor when sick, or went without a recommended medical test or treatment, compared with 28 percent of people who had more adequate health insurance. Half (52%) of underinsured and 58 percent of uninsured adults had trouble paying medical bills, were contacted by a collections agency over unpaid bills, had to change their way of life to pay medical bills, or were paying off medical debt over time. In contrast, about one fourth (27%) of adults with adequate health insurance reported such medical bill stress and debt.
How The Affordable Care Act Will Help The Underinsured
The study finds that Affordable Care Act reforms like premium assistance and reduced cost-sharing for lower and modest income families will provide significant support to those most likely to be underinsured-people with incomes below 250 percent of the federal poverty level, or $56,000 a year for a family of four. Seven out of 10 of the underinsured, and a similar share of those uninsured during the year, had incomes this low in the study.
The new law will also provide sliding scale premium assistance to families making up to 400 percent of poverty or $88,000 a year for a family of four. However, the study notes that those with incomes above 250 percent of poverty ($56,000 for a family of four) could face out-of-pocket costs that are high relative to their incomes if plan designs permit high deductibles or high cost-sharing for essential care.