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Low-Income Adults Less Likely To Have Coverage, Regular Source of Care

Low-income U.S. residents are less likely to have health coverage and access to a regular source of care than adults with higher incomes, according to a Commonwealth Fund survey released on Tuesday, Modern Healthcare reports (Evans, Modern Healthcare, 2/7).

The online survey -- conducted by Knowledge Networks from June 24, 2011, through July 5, 2011 -- included 2,134 U.S. residents between ages 19 and 64. The survey is the first in a series that the Commonwealth Fund is planning to track changes in coverage resulting from the federal health reform law (Quinton, National Journal, 2/7).

Survey Findings

The survey found that families with annual incomes of less than 133% of the federal poverty level -- or about $29,726 for a family of four -- were the least likely of all income categories to be insured. For example, the survey found that 33% of adults in families with annual incomes of less than 133% of FPL have lacked insurance for two years, 10 times higher than the rate of adults with incomes higher than 400% of FPL (Rau, "Capsules," Kaiser Health News, 2/7).

The survey found that:

  • 57% of adults in families with incomes of less than 133% of FPL were uninsured during 2011; and
  • 36% of adults with incomes between 133% and 249% of FPL lacked insurance during 2011 and 23% had been uninsured for one year or more.

The study also found that low-income adults were more likely to cite factors other than medical emergencies as reasons for going to the emergency department and less likely to be up-to-date on recommended preventive services, such as cancer screenings and cholesterol testing. For example:

  • 44% of adults with annual incomes less than 133% of FPL went to an ED during the evening or on weekends, compared with 23% of adults with incomes above 400% of FPL;
  • 35% of insured adults with incomes under 250% of FPL used an ED to get a prescription, compared with 17% of insured adults with incomes at or above 250% of FPL;
  • 10% of uninsured adults with incomes under 250% of FPL had received a recommended colonoscopy, compared with 50% of those with insurance and comparable incomes.


Though the health reform law is slated to expand Medicaid eligibility in 2014, the survey authors noted that increased insurance coverage "is a necessary, though not sufficient, condition for ensuring equal access to timely health care across income levels. People will need both health insurance and timely access to physicians and clinics who know them and their medical histories."

Lead researcher Sara Collins, vice president of Affordable Health Insurance at the Commonwealth Fund, said the survey "really does point to the need for the other provisions in the law that are aimed at bolstering the primary health care system, in particular, the large expansion and resources for community health centers" (Bristol, CQ HealthBeat, 2/7).

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