About 31M U.S. Residents Were Underinsured in 2014, Report Finds
The survey noted that figure has doubled since 2003, largely driven by an uptick in high-deductible health plans (Ferris, The Hill, 5/20).
The findings come from Commonwealth Fund's biennial survey of working-age U.S. residents. The findings considered individuals to be underinsured if they had health coverage but were responsible for out-of-pocket medical costs exceeding what they could afford (Evans, Modern Healthcare, 5/20).
According to The Hill, the survey did not account for individuals who were uninsured prior to 2014. The survey was therefore not able to assess the Affordable Care Act's effects (The Hill, 5/20).
The survey found that 14 million U.S. adults were underinsured in 2014 because their health plans' deductibles amounted to at least 5% of their annual incomes. That number is up from 11 million who were considered underinsured because of high-deductible health plans in 2012.
The survey found that 11% of privately insured U.S. adults in 2014 had deductibles of at least $3,000. In comparison, about 1% of such individuals had deductibles of $3,000 or in 2003. Further, the survey found that 27% of survey respondents had deductibles ranging from $1,000 to $2,900 last year (Modern Healthcare, 5/20). According to the survey, 50% of underinsured adults and 41% of adults with private coverage who had deductibles of at least $1,000 reported they had to pay at least $4,000 in accumulated medical bills (The Hill, 5/20).
Meanwhile, an additional 24 million U.S. adults had lower deductibles but were underinsured when accounting for the cost of deductibles, co-insurance, copayments, out-of-network provider use and health services not covered under their plans. Individuals who fell into this category were considered underinsured if their total out-of-pocket costs equaled at least 10% of their annual incomes. Individuals with incomes of 200% of the federal poverty level were considered underinsured if their total out-of-pocket costs equaled at least 5% of their annual incomes.
Overall, the survey found that 23% of U.S. adults were underinsured last year, similar to the rate in 2012 (Modern Healthcare, 5/20). According to the survey, individuals who were employed by small businesses were more likely to be underinsured (The Hill, 5/20).
High Deductibles Driving Underinsurance
According to Modern Healthcare, the survey results showed that high-deductible health plans increasingly caused underinsurance and financial distress. The hardships particularly were evident among those with the lowest incomes, as well as those with acute medical conditions.
According to the survey, underinsured individuals were as likely as uninsured individuals to report medical debt or issues with medical bills. In addition, underinsured individuals were almost as likely as uninsured individuals to say they had trouble paying for medical bills. Underinsured individuals also reported skipping medical care more frequently than those with more comprehensive health plans.
Sara Collins, one of the report's authors and vice president for health care coverage and access at the Commonwealth Fund, said the findings show "that high front-end out-of-pocket costs do deter people's use of health care services that they need." She added that health plans should be designed to encourage individuals to seek medical care without worry of financial hardship but that high-deductible coverage seems to do the opposite.
To address this issue, Collins called for benefit design changes that would remove some barriers to care, as well as bolster access to preventive care to help stave off illness and better manage chronic diseases. In addition, Collins warned that continued growth of high-deductible health plans could cause more people to become underinsured (Modern Healthcare, 5/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.