Report shows soaring health-care costs are straining Americans' ability to pay
By Amanda Gardner
HealthDay Reporter
WEDNESDAY, April 26 (HealthDay News) -- Being uninsured is a growing problem not just for the poor, but for middle-income Americans, too, a new report warns.
In fact, 41 percent of working-age Americans with annual incomes between $20,000 and $40,000 were uninsured for at least part of the past year, up from 28 percent in 2001, analysts found.
In addition, one in every five working-age adults, whether insured or not, were toiling to pay off medical debt.
"These data show that lack of health insurance is becoming increasingly a problem of families of moderate incomes. The rates of uninsurance in this income group have gone up steadily," said Sara Collins, lead author of the report and senior program officer for the Commonwealth Fund, in New York City. "The other thing that really stands out is that so many working-age adults are carrying debt from medical bills."
"This report does confirm and reinforce a lot of things that we know have been happening," added Carol Pryor, senior policy analyst at the Access Project, in Boston. "One is that with insurance premiums continually going up at a rapid rate and coverage eroding, we're finding that even moderate- and middle-income families are starting to find insurance unaffordable, with the result that the number of uninsured in those groups is rising."
The report, Gaps in Health Insurance: An All-American Problem, was released Wednesday by the nonprofit Commonwealth Fund.
As the document pointed out, national health-care spending has been climbing by more than 7 percent each year, far outpacing the country's rate of economic growth. As health-care costs rise, more people find themselves without health insurance. In 2004, nearly 46 million people were uninsured, vs. 40 million in 2000.
Among the report's other findings:
- Lower-income adults (earning under $20,000 a year) remained the most likely to be uninsured, with 53 percent spending time uninsured during the past year.
- Most uninsured people are in working families, with about two-thirds of uninsured people in families where at least one person was working full time.
- More than four of five (82 percent) uninsured adults had been uninsured for one year or longer.
- Overall, 21 percent of adults, both insured and uninsured, currently had medical debt they are paying off over time. Thirty-four percent either had experienced medical bill troubles over the past year or still were paying off accrued medical debt.
- More than half of uninsured adults had medical debt or bill problems and, of these, slightly under half said they had depleted their savings to pay the bill. Two out of five were unable to afford food, heat or rent because of astronomical medical debt.
- Sixty-two percent of adults with medical bills or medical debt said that they or another family member were insured when they incurred the debt.
- Forty-four percent of working-age adults with medical debt reported it was $2,000 or more.
- Being uninsured takes an especially heavy toll on people with chronic conditions. Fifty-nine percent of adults who spent time without health insurance during the past year had chronic illnesses such as diabetes or asthma, and had to forego or skip medications because they couldn't afford them. More than one-third of uninsured adults with chronic conditions visited an emergency room or stayed in the hospital overnight, vs. 16 percent of those who were insured all year. "This really leaves one concerned about the ability of us as a society to manage chronic conditions that ultimately become very costly to families and to the health system," Collins said.
- People without health insurance were more likely to go without recommended preventive screening. Only 18 percent of adults aged 50 to 64 who were uninsured had a colon cancer screening in the past five years, compared with 56 percent of insured adults. Less than 48 percent of women aged 50 to 64 who were insured had a mammogram in the past two years, vs. three-quarters of insured women. Slightly more than one-third (35 percent) of uninsured adults had a dental exam during the past year, vs. 70 percent of those with insurance.
- Only 41 percent of uninsured adults had a regular doctor or other health-care provider, compared with 86 percent of insured adults.
Data on insured adults vs. uninsured adults may only be telling part of the story, experts said.
"The distinction between uninsured and insured isn't as simple as it used to be," Pryor said. "When we look at people who are insured, we need to know not only if they have insurance, but do they have adequate insurance. So, the numbers could be misleadingly low."
And some say the situation appears not to have been mitigated by recent policies.
"This calls into question a lot of the policies that have been put forward in the last few years about solving the health-care crisis by supposedly empowering consumers by having them pay more of the cost of care," Pryor said. "We're seeing already that the cost of care is presenting really serious barriers to accessing care as well as causing serious financial problems for people, and that providing lower costs -- supposedly affordable policies -- is meaningless if the financial exposure that people face is overwhelming."
SOURCES: Sara Collins, senior program officer, The Commonwealth Fund, New York City; Carol Pryor, senior policy analyst, The Access Project, Boston; Gaps in Health Insurance: An All-American Problem
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