ACA still not reducing ranks of uninsured


An estimated 55 million U.S. adults – or 30% of those aged 19-64 years – were without health insurance coverage at some point last year, according to the Commonwealth Fund’s biennial survey of health insurance.

Another 30 million (16%) were considered underinsured because their out-of-pocket health care costs were high relative to income.

Many uninsured and underinsured adults also faced significant medical debt or had trouble affording health care visits and prescriptions, according to the report.

Dr. David Blumenthal

"The costs of health care and health coverage in the United States have been on an unsustainable upward trajectory over several decades, straining family and government budgets," Dr. David Blumenthal, president of the Commonwealth Fund, said during a press conference April 25.

When it comes to young adults, those aged 19-25 years, the rate of uninsurance has actually fallen – from 48% in 2010 to 41% in 2012. The researchers said the Affordable Care Act (ACA), which includes a provision allowing adults under age 26 to stay on their parents’ health plan if they can’t gain employer-sponsored insurance, is likely the reason behind the upswing in coverage in this group.

Other Americans are likely to gain coverage starting in January 2014, when most of the insurance coverage expansions of the ACA begin to take effect, Dr. Blumenthal said.

"Our expectation is that we will begin to see positive changes in our health care system when the major coverage provisions of the law launch in 2014," Dr. Blumenthal said. "But the changes won’t happen overnight."

Of the 55 million adults who were uninsured in the 2012 survey, about 87% would be eligible either for Medicaid or for a federal subsidy to help with the purchase of insurance under the ACA, according to the Commonwealth Fund. However, not everyone who is eligible for the benefits will take advantage of them because either they do not know they are eligible, they can’t find a premium they can afford, or they choose not to enroll. Also, following the Supreme Court decision on the ACA in 2012, states are not required to expand their Medicaid programs up to 133% of the federal poverty level, so there is likely to be patchwork of Medicaid coverage across the country.

In the meantime, U.S. adults who are uninsured or underinsured are having problems accessing care and paying medical bills.

The survey found that 43% of U.S. adults were missing out on necessary care due to cost, up from 37% in 2003. For instance, some people reported that they didn’t visit a doctor when they were sick, skipped recommended tests, or failed to fill prescriptions because of concerns about the cost.

The cost of health care was a significant barrier to access for Americans who were uninsured or underinsured. But it was also a problem for some adults with adequate insurance. Among those with adequate insurance, 28% reported cost-related problems.

Medical debt also continues to be a problem. In 2012, 41% of U.S. adults reported problems paying their medical bills or said they were paying off medical debt over time. Of those adults who had trouble paying their medical bills, 42% said they had received a lower credit rating as a result and 37% reported that they had used all of their savings in an attempt to pay off their medical bills.

The findings are based on a telephone survey conducted from April 26 to Aug. 19, 2012, of a nationally representative sample of more than 4,400 adults aged 19-64 years.

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