How Skewed is the 46 Million Uninsured #?

[FayeforCure]

We already know we are up to almost 50 Million uninsured Americans, but a favored talking point of conservatives is that many people CHOOSE to be uninsured.

Obviously if you happen to have cancer or any other pre-existing condition you are out of luck, because the insurance companies will be the ones CHOOSING to NOT insure you. But is the conservative claim even remotely true?

Let's check an NIH report:

Uninsured and Overlooked: Middle Income Americans Who Fall Through the Cracks in the Health Insurance System.

Quinn K; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 87.
Consultec Inc., 34 N. Last Chance Gulch, Helena, MT 59601, Phone:                (406) 449-7693         x306, Fax: (406) 442-2819, E-mail: kevin.quinn@consultec-inc.com

RESEARCH OBJECTIVE: To identify why people who are not poor, or even near-poor, lack health insurance and how the lack of coverage affects them.

STUDY DESIGN: Analysis of the Commonwealth Fund 1999 National Survey of Workers' Health Insurance, the March 1999 Current Population Survey, a tax simulation model, and an informal but structured survey of individual health plans available on the Internet.

POPULATION STUDIED: People in the non-institutionalized population who had incomes exceeding 200% of the poverty level, were under age 65, and lacked health insurance in 1998.

PRINCIPAL FINDINGS: Of the 44 million people who lacked coverage in 1998, 16 million had family incomes that exceeded 200% of the poverty level. Of these 16 million, almost 90% did not have access to employer-sponsored coverage.

In the small group that was offered benefits but turned them down, the most common reason was cost. A minuscule percentage turned down coverage because they believed they do not need it.

Though these people were not poor, neither did they tend to be well-off. Of the 16 million uninsured, four out of five had family incomes in the middle quartiles of the income distribution, that is, between $17,700 and $65,200.

People without access to an employer plan faced sharply higher costs to obtain coverage.

For a family of three with income of $50,000, a tax simulation shows that the after-tax cost of buying a typical plan was 11% of income when bought individually but 3% when bought through an employer. An analysis of several dozen individual plans sold on the Internet shows that these plans are often worse value than the typical plan used in the tax simulation. In this income group, 35% of uninsured people reported going without needed care and 41% reported problems paying medical bills. Both percentages were more than twice as high than for insured people. Poor health status was also correlated with lack of coverage; in this income group, 31% of the uninsured reported health status less than excellent or very good, compared with 22% of the insured.

CONCLUSIONS: The evidence shows that the affordability of health coverage has as much to do with access to an employer plan as with income. Moreover, even for people with incomes well above poverty, lack of insurance is correlated with worse health status, decreased access to health care, and greater financial problems.

IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE:

Current federal policy supports health insurance for the non-elderly through two main routes.

One is direct: approximately $100 billion was spent on Medicaid and children's health insurance programs in 1998.

The other is indirect: the exclusion from taxation of employer-sponsored premiums, which amounted to at least $102 billion in 1998.

People whose incomes exceed 200% of poverty and who do not have access to an employer plan receive essentially no benefit from either subsidy program.

Since the cost of individual insurance can easily exceed what the typical family spends on groceries in a year, it is unsurprising that even middle-income Americans often do not buy it. The consequence, however, appears to be increased health and financial problems.

PRIMARY FUNDING SOURCE: The Commonwealth Fund Task Force on the Future of Health Insurance

http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102273322.html