The numbers aren’t too pretty. Underinsured adults — those with health insurance all year and very high medical expenses relative to their incomes, rose by 80% between 2003-2010, from 16 million to 29 million. Nearly half 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 staggering stats come from the study, Affordable Care Act Reforms Could Reduce the Number of Underinsured U.S. Adults by 70 Percent, authored by staff of The Commonwealth Fund, and published in Health Affairs.
The study makes clear that merely having insurance is not enough. Having the right amount and type of coverage matters more. “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,” says Mary Mahon, assistant vice president of public information at The Commonwealth Fund.
Other Study Highlights
Low-income families were most at risk of being underinsured. Three-quarters (77%) of those with incomes below 133 percent of the poverty level and more than half (58%) of those with incomes between 133 percent and 250 percent of the poverty level were either underinsured or uninsured.
The risk of being underinsured is rising up the income scale. In 2010, 16 percent of adults with incomes between $40,000 and $60,000 were underinsured and another 19 percent were uninsured. In 2003, only 5 percent of adults with incomes in this range were underinsured.
Rates of forgone care (e.g., not filling a prescription or not following up on recommended tests or treatment) were twice as high among the underinsured and three times as high among the uninsured as rates reported by adults with more adequate insurance.
The good news, says Mahon, is that 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% once the law is fully implemented. 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% of the federal poverty level, or $56,000 a year for a family of four, says Mahon. Seven out of 10 of the underinsured, and a similar share of those uninsured during the year, had incomes this low in the study.
However, she cautions, “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.”