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Health care expenses that exceed 10% of pretax family income is one measure of "underinsurance." More than 61 million Americans are in families that will spend more that 10 percent of their pre-tax income on health care (up from 37.1 million in 1996) and 13.5 million are in families that spend over 25% of their pre-tax income on health care. More than four out of five people (82.4%) in families spending more than 10% of their pre-tax income on health care costs have health insurance. Similarly, three-fourths (75.8 percent) of those spending more than 25% of their pre-tax income on health care costs have health insurance. (from Families USA 12/20/07, based on data from the Bureau of Labor Statistics' Consumer Expenditure Survey)
Remember that even the official US Census numbers of "uninsured" Americans underestimate the problem, since they include only those uninusred continuously from Jan 1 through Dec 31. That is they do not count those who were uninsured from February of one year through October of the NEXT YEAR as uninsured in either year, even though they were uninsured for 22 months. Still, using the conservative measure of underinsurance (those actually unable to meet their health expenses) it has been estimated that 1/3 again as many Americans were underinsured in a year as those officially counted as uninsured. (Insured But Not Protected: How Many Adults Are Underinsured? June 13, 2005 by C. Schoen et.al.)
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UNDERINSURANCE: THE SLEEPING GIANT OF OUR CRISIS
The share of nonelderly American adults with adequate health insurance declined from 65% to 58% between 2003 and 2007. Adding uninsured and underinsured adults together, an estimated seventy-five million adults -- 42 percent of the under-sixty-five adult population -- had either no or inadequate insurance in 2007, up from 35 percent in 2003. [This estimate used the more liberal and accurate method of considering health care costs compared to income].
By 2007 barely half of those with incomes of 200-299 percent of poverty were insured all year with adequate coverage. Nearly one-third had a time uninsured, and 16 percent were underinsured. Controlling for income, health status, and other characteristics, underinsured and uninsured adults were significantly more likely to go without care because of costs than were those with more protective insurance and no time uninsured. About half of uninsured and nearly half of underinsured adults reported difficulty paying bills, being contacted by collection agencies for unpaid bills, or changing their way of life to pay their medical bills.
An estimated two in five underinsured adults spent 5% or more, and one-fifth spent 10% or more, of family income on premiums alone [not considering the portion of income spent otherwise on health care]-- more than three times the premium-to-income pattern in the comparison group.
The article may still be accessible CLICK HERE
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from US House of Representatives, Committee on Ways and Means, Subcommittee on Health, Hearing on the Instability of Health Coverage in America, April 15, 2008, Statement of Stephen Finan, Associate Director of Policy, American Cancer Society
Much of the public debate is about the need to cover the 47 million uninsured, and the American Cancer Society fully shares that concern. However, we need to recognize more fully the very significant problem of underinsurance. Health plans vary enormously in their deductibles, co-pays, benefits covered, and exceptions.
Insurance plans are written in very detailed legalistic language that very few lay people can begin to comprehend, and the summary plan documents that are provided to enrollees almost never begin to convey the adequacy of coverage. Put another way, if you were to look at an array of plans that might be available to you as a consumer, and you were to ask, what would be the adequacy of your coverage if you were to be diagnosed with cancer or some other serious disease, you would probably conclude that you have no idea whether the plan would be adequate. People often discover after their diagnosis what their plan really means and that is a point where for most patients it is virtually impossible to change coverage.
The testimony may still be accessible CLICK HERE
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UNDERINSURANCE IS ALMOST AS BAD AS NO INSURANCE
Health Affairs of June 14, 2005 by C Schoen, MM Doty, SR Collins, AL Holmgren
Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. Nearly sixteen million people ages 19-64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35% of adult Americans were under- or uninsured.
The authors only included as underinsured who were insured all year but reported either: (1) Medical expenses amounting to 10 % of income; (2) among low-income adults (below 200 % of the federal poverty level), medical expenses amounting to at least 5 % of income; and (3) health plan deductibles equaled or exceeded 5 % of income. [People who were underinsured but who were fortunate enough not to incur large expenses during the year were not counted as underinsured. EINO would argue those counted were merely the suffering underinsured, a small percentage of those underinsured. Insurance and underinsurance need to be measured independent from individual health fortune.].
The article's abstract may be accessible CLICK HERE
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Nearly Half
the Surveyed Physicians said They Could Not Get the Mental Health Benefits
Their Patients Needed
Parity for mental health care? How about offering some services at all for mental health? Note that
there are huge and uncalculated costs to society from untreated mental disease (personal, familial and
tremendous financial losses as well. Think of substance abuse, crime control, prisons, as well as lost
productivity to businesses.
From Center for Studying Health System Change 1997 survey
(data shown for inpatient care)
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Four of five of the experts surveyed believe that it is important or very important to secure adequate financing of long-term care, improve quality of long-term care facilities, and develop a health care workforce that is sufficient in size and skill to provide long-term care. Adding a long-term care benefit to Medicare, financed by a premium, is favored by nearly four of five respondents. Over two-thirds (69%) say it is important or very important for presidential candidates' health reform plans to address quality and financing of long-term care.
More than two-thirds of respondents to the latest believe it is important that the health reform plans of the presidential candidates address the quality and financing of long-term care.
Ensuring adequate financing, improving the quality of services, and developing an adequate, skilled long-term care workforce are some of the urgent challenges facing long-term care in the future, said four of five opinion leaders surveyed, who included experts from academia, health care delivery, health industry, business, labor, consumer advocacy, and government. Four of five respondents (79%) favor or strongly favor adding a long-term care benefit to Medicare, financed by a premium, to pay for care. And a majority believes that long-term care costs should be shared by individuals and the government (55%), while one-quarter (26%) say costs should be shared by individuals, employers, and the government.
HEALTH CARE OPINION LEADERS' VIEWS ON THE FUTURE OF LONG-TERM CARE July 21, 2008 Commonwealth Fund Michelle Doty, Ph.D., Mary Jane Koren, M.D., M.P.H., and Karen Davis, Ph.D.Original Article
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HMOs Tend to Recruit
Healthy (less expensive) Patients into their Plans
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They then tend to release those that get sick, to be cared for by other companies or often at the public expense. In this way they specialize in collecting premiums not in taking risks, or assuming costs for the most unfortunate.
From NEJM 1997 337:169
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Denial Rates Among Groups with Specific Problems and Needs
(for non-Group coverage)
From Health Affairs 2002; W732
* The 8.4 million is Americans with all types of cancer
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PERCENT OF FAMILIES REPORTING PROBLEM
IN LAST 12 MONTHS
Difficulties with Health Care Access Reach Up Into Middle Class
From NPR/ Kaiser Survey of June 2002
Problems in Paying Bills and Collection Agency refer to Medical Debts Only
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OUT-OF-POCKET COSTS TO SENIORS RISING
(shown as percent of whole senior income)
AARP Apr 95 & Mar 98; Commonwealth Fund May 1999 projections
2025 projection includes nursing home costs
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MANY AMERICANS CAN’T AFFORD THEIR PRESCRIPTIONS
Percent not filling a prescription in past 12 months due to cost.
From Center for Studying Health System Change, Issue Brief #51 April 4, 2002
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INSURED BUT NOT PROTECTED: How Many Adults Are Underinsured?
Some 45 million uninsured American adults lack health insurance, but at least 16 million more were underinsured in 2003, meaning they did not have enough financial protection to cover their health expenses. The study found that the estimated 61 million with no insurance, sporadic insurance, or insurance that exposed them to catastrophic medical costs were at increased risk for not being able to obtain the quality care they needed. Half of the underinsured went without at least one of four needed medical services, double the rate of those with adequate insurance. Two-thirds of the sicker adults who were underinsured went without needed care. Nearly half of underinsured adults with chronic disease or poor health did not take their medications as prescribed.
For article by C Schoen, MM Doty, SR Collins, and AL Holmgren published in 2005 CLICK HERE
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CHILDREN AS CAREGIVERS
An estimated 1.3 million U.S. children aged 8 to 18 provide essential care for relatives who are ill or have disabilities, according to a study by the United Hospital Fund. The results are based on a phone survey of 2,000 US households. Most child caregivers are helping parents or grandparents with illnesses such as Aizheimer’s or cancer; 58 % are helping with at least one routine daily activity; such as bathing or eating; nearly all help with shopping and household tasks; and child caregivers have more anxiety and depression than other children. Caregiving children are more likely to be from low-income, minority and single-parent families.
From the Kaiser Daily Health Policy Report, 9/14/2005.
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GW BUSH PLEDGE QUICKLY FORGOTTEN
Despite Pres GW Bush’s pledge to expand community health centers to every poor county in America, a survey by the National Association of Community Health Centers and the George Washington University found 929 poor counties (more than half of all poor counties) lacked even one health center. In FY 2002 and 2003, allotted funding allowed only one-third of qualified applications for new centers to gain funding. In 2004, 90% of qualified applications were rejected.
"Growing Uninsured, Budget Cutbacks", Natl Assn of Community Health Centers, March 2005 report by Prosner, M.
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WHO IS UNDERINSURED IN THE USA, A CONSERVATIVE DEFINITION
15.6 million US adults are underinsured and often go without needed care and medications due to costs, according to a survey of 3,293 adults ages 19 to 64. An "underinsured" individual was defined as someone with health expenses that exceed 10% of their income (5% for low-income individuals) or with a health care deductible higher than 5% of their income.
EINO: This is a ridiculously conservative definition of "underinsured". Why not let the Bush Administration define "uninsured" the same way, then they could just count those who were without any health insurance continuously Jan 1 - Dec 31 AND who were seriously ill or injured. That would allow them to "decrease the nation's uninsurance rate" overnight without taking any action! So the underinsured in Jan 2005, then, by this conservative definition, who had huge expenses relative to income during that month were not "underinsured" for any of the twelve previous months, even though they suffered the same lack of coverage? What were they? Fully insured? Where do their statistics show up in analysing how many Americans will go untreated and/or impoversh their families should they get ill? Would it be fair to say that at least twice this amount (31 million) are without adequate coverage?
Commonwealth Fund, August 2005
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HOW MANY ARE UNDERINSURED? TRENDS AMONG U.S. ADULTS, 2003 AND 2007
With health insurance moving toward greater patient cost sharing, this study finds a sharp increase in the number of underinsured people. Based on indicators of cost exposure relative to income, as of 2007 an estimated 25 million insured people ages 19-64 were underinsured -- a 60% increase since 2003. The rate of increase was steepest among those with incomes above 200% of poverty, where underinsurance rates nearly tripled. In total, 42% of U.S. adults were underinsured or uninsured (before the severe recession of 2008-09).
Including those uninsured during the year, the share of nonelderly adults with adequate health insurance declined from 65% to 58 percent between 2003 and 2007. An estimated 14% of all nonelderly adults were underinsured in 2007, and more than one in four adults (49.5 million) were uninsured all or part of the year. Adding uninsured and underinsured adults together, an estimated seventy-five million adults -- 42% of the under-sixty-five adult population -- had either no or inadequate insurance in 2007, up from 35% in 2003.
Health Affairs, June 10, 2008 HOW MANY ARE UNDERINSURED? TRENDS AMONG U.S. ADULTS, 2003 AND 2007 by Cathy Schoen, Sara R. Collins, Jennifer L. Kriss, and Michelle M. Doty
Original Article
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FALLING BEHIND: AMERICANS' ACCESS TO MEDICAL CARE DETERIORATES, 2003-2007
The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007. One in five Americans 59 million people reported not getting or delaying needed medical care in 2007, up by 42% from one in seven in 2003.
Access declined more for people in fair or poor health than for healthier people. In addition, unmet medical needs increased for low-income children, reversing earlier trends and widening the access gap with higher-income children. People reporting access problems increasingly cited cost as an obstacle to needed care, along with rising rates of health plan and health system barriers. While cost continued to be the overwhelming concern among uninsured people (more than 90% of uninsured people reported cost as a barrier across all three surveys), the increase in cost barriers occurred mostly among insured people. Higher patient cost sharing, people facing higher deductibles and other increased out-of-pocket expenses for medical services, likely is driving growing cost concerns among insured people.
The health plan-related barriers that people increasingly cited were that their health plan would not pay for treatment (9.2 percentage point increase), followed by the doctor or hospital would not accept their insurance (4.5 percentage point increase). The return of health plan prior-authorization requirements for certain services may be a contributing factor. Also, rising insurance deductibles or coinsurance that cause people to be responsible for much or all of a medical bill may contribute to some people reporting that their health plan would not pay for the treatment. The increase in people reporting that their doctor would not accept their insurance may mean more doctors are opting out of private insurance networks or not accepting new Medicare or Medicaid patients.
Center for Studying Health System Change June 2008 FALLING BEHIND: AMERICANS' ACCESS TO MEDICAL CARE DETERIORATES, 2003-2007 by Peter J. Cunningham and Laurie E. Felland Original Article
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INSURANCE IS BURDENING WORKING FAMILIES
The economic downturn is forcing working families across the USA to make tough financial choices, often involving sacrificing needed health care and health insurance. Using data from four years the status of health insurance for U.S. adults under age 65 and the implications for family finances and access to health care were examined. Insurance coverage deteriorated over the past six years, with declines in coverage most severe for moderate-income families. As result, more families are experiencing medical bill problems or cost-related delays in getting needed care. In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured. All this, before the severe recession of 2008-09.
Declining insurance coverage and rising health care costs are likely contributing to skimping on needed care. The share of U.S. adults reporting that the costs of health care prevented them from getting needed care increased from 29% in 2001 to 45% in 2007. Reports of cost-related access problems rose across all income groups and among both insured and uninsured adults.
INSURANCE IS BURDENING WORKING FAMILIES, Commonwealth Fund, August 20, 2008 | Volume 99 Sara R. Collins, Ph.D., Jennifer L. Kriss, Michelle M. Doty, Ph.D., and Sheila D. Rustgi
Original Article
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TRADE-OFFS GETTING TOUGHER: PROBLEMS PAYING MEDICAL BILLS INCREASE FOR US FAMILIES, 2003-2007
About 57 million Americans were in families with problems paying medical bills in 2007an increase of 14 million people since 2003. Problems paying medical bills increased for both nonelderly insured and uninsured people. Although the rate of medical bill problems is much higher for uninsured people, most people with medical bill problems 42.5 million had insurance coverage. About 2.2 million people with medical bill problems were in families that filed for bankruptcy as a result of their medical bills, and a much larger number reported other financial consequences, such as problems paying for other necessities and having to borrow money. The increase in medical bill problems especially among insured people is the main reason why more people reported unmet medical needs because of cost in 2007 than in 2003.
TRADE-OFFS GETTING TOUGHER: PROBLEMS PAYING MEDICAL BILLS INCREASE FOR U.S. FAMILIES, 2003-2007 Center for Studying Health System Change September 2008 By Peter J. Cunningham
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