October 18, 2022

Underinsured and Unable to Afford Care

The share of Americans who lack health insurance is at historic lows. Even so, being uninsured and underinsured is a problem. I’ve seen what this means for members of my own family.

Example 1: a man in his early 60s with a high-deductible employer plan. His 60-year-old wife, after working for years as a waitress, has had knee surgery and other problems. Each major treatment racks up thousands of dollars in bills they struggle for months to pay.

Example 2: a 62-year-old woman working as a low-wage independent contractor. She is uninsured and has painful arthritis. She frequently cancels jobs because she is sick.

Example 3: a construction worker also in his 60s with a high insurance deductible. He rarely goes to the doctor because he pays cash for just about everything under a policy purchased on a state health insurance marketplace.

Nearly half of working-age Americans recently surveyed said they have skipped or delayed medical care because they couldn’t afford it, reported a healthcare nonprofit. People are considered to be underinsured in the report either because they lack insurance altogether or have a policy that is unaffordable, meaning that it uses at least 10 percent of the household’s yearly income.

Specific decisions the underinsured make include not seeing a doctor if they have a problem, not following through on recommended treatments for a diagnosed illness, not seeing a recommended specialist, or not filling a prescription, the Commonwealth Fund’s report said.

Affordability remains a problem despite Congress’ move to encourage people to buy coverage during COVID by slashing the premiums for federally subsidized policies purchased on the national and state insurance marketplaces. The Biden administration just extended the premium subsidies through 2025. …Learn More

March 5, 2020

State Uninsured Rates All Over the Map

A decade after the passage of the Affordable Care Act, about one out of every five Texans under age 65 still do not have health insurance. Georgia, Oklahoma and Florida are close behind.

The contrast with Hawaii, Minnesota, Michigan, and New Hampshire is stark – only about one in 20 of their residents lacked insurance in 2018, the most recent year of available data, according to the Kaiser Family Foundation’s annual roundup of insurance coverage in the 50 states.

Despite this glaring disparity, the share of Americans lacking coverage has dropped dramatically across the board, including in Texas. Texas’ uninsured rate fell from 26 percent in 2010 to 18 percent in 2018. This translates to 2.3 million more people with health insurance. (Large populations of undocumented immigrants in states like Texas can push up the uninsured rate.)

States that had fairly broad coverage even prior to the Affordable Care Act’s (ACA) 2010 passage didn’t have as far to fall. For example, Connecticut’s uninsured rate is 6 percent, down from 10 percent in 2010.

One upshot of these two trends is that the disparity between the high- and low-coverage states has shrunk. Certainly, the strong job market gets credit for reducing the ranks of the uninsured. But millions of Americans who don’t have employer insurance have either purchased a policy on the insurance exchanges or gained coverage when their state expanded Medicaid to more low-income residents under the ACA.

For example, just two years after Louisiana’s 2016 Medicaid expansion, the uninsured rate had fallen from 12 percent to 9 percent.

But the initial benefits of the ACA seem to have played out. The U.S. uninsured rate increased slightly, from 10 percent to 10.4 percent between 2016 and 2018.

The share of people who are underinsured is also rising, the Commonwealth Fund found in a recent analysis. …

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