The Uninsured at Risk

In 2009, the number of uninsured reached 50 million people nationwide. The 2010 Patient Protection and Affordable Care Act was designed to decrease the number of uninsured individuals by providing Medicaid or subsidizing coverage to qualifying individuals with incomes up to 400% of the poverty level. A recent Kaiser Family Foundation report, Medicaid and the Uninsured, provided data on the risks associated with those who are uninsured. A majority of those who are uninsured have low to moderate incomes, with 40% of uninsured individuals living below the poverty line. Because the elderly and children are more likely to be covered by Medicaid, young adults have the highest uninsured rate. Uninsured adults are twice as likely as privately insured adults to have no education beyond high school (61% vs 31%), making it difficult for them to obtain jobs with better benefits. For those who are uninsured, this problem remains long term; approximately 75% of the uninsured remain uninsured for ≥1 year. Of those who are uninsured, 77% come from working families. The recent recession has made obtaining insurance difficult for those who are self-employed or those who work for smaller companies. Although some smaller firms offer health insurance, the premiums may be too high for individuals to afford. A recent government survey indicates 72% of adults report one of the reasons they are uninsured is because the cost is too high. Since 2005, workers’ share of premiums has risen 47%. Twenty-six percent of uninsured adults go without needed care each year because they cannot afford it. The uninsured are much more likely to forgo preventive care and services for major health conditions and many suffer serious consequences. Those who have been uninsured for ≥1 year are 3 to 4 times more likely to have not received recommended breast cancer screenings or to have not had their blood pressure checked. Because only emergency departments are required by law to screen and stabilize all individuals, many uninsured people are turned away when seeking care. Those without coverage are generally not as healthy as those who are insured. Uninsured individuals pay for 35% of their care out-of-pocket. A large problem uninsured individuals face is not being able to pay their increasingly large medical bills. This leads to medical debt, because these low-to-moderate income individuals have little or no money in savings, and the average uninsured household has no net assets. The uninsured are 3 times as likely as the insured to be unable to pay for basic necessities due to medical debt. An estimated 27% of the uninsured report having used all or most of their savings to pay medical bills. The build-up of medical bills and the inability to seek care can lead to anxiety for many people, manifesting in physical, financial, and psychological health concerns. Sixty-three percent of the uninsured are not confident that they can pay for their family’s usual medical costs. One third of uninsured adults have been contacted by a collection agency about their medical bills in the past year. During the recession, the number of individuals covered by Medicaid increased to offset declines in private coverage; however, Medicaid is typically only available to low-income children, parents, pregnant women, people with disabilities, and the elderly who meet certain income criteria, leaving adults without dependent children ineligible regardless of income. The healthcare reform law will expand Medicaid to nearly all of the nonelderly at or below 138% of poverty in 2014. The new law will also strengthen coverage for preventive care and seeks to improve healthcare coordination, which will help the uninsured gain access to needed services once they are insured. This law will expand the scope of coverage and protect against excessive out-of-pocket costs. Under the new law, there is hope that the number of uninsured individuals will decrease. Extending Medicaid will likely decrease the physical and financial troubles the uninsured face, according to the results from Kaiser’s research.