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Health Insurance Survey: 84 Million People Were Uninsured or Under-Insured in 2012

Findings have important implications for health care reform (Apr. 26)

A new report issued by the Commonwealth Fund finds that in 2012 an estimated 84 million people did not have health insurance for the full year or were underinsured — and thus were unprotected from high out-of-pocket medical costs. Based on the Fund’s 2012 Biennial Health Insurance Survey, the analysis also found that millions of U.S. adults are struggling to pay medical bills and are avoiding timely health care for financial reasons.

Nearly half (46%) of adults aged 19 to 64 years nationwide either had been uninsured for a time last year or were underinsured. In addition, 41% of adults — an estimated 75 million people — reported that they had problems paying medical bills or were paying off medical debt over time.

Cost was found to be a substantial obstacle to Americans’ ability to secure timely health care. In the survey, 43% of adults (80 million people) said that they had not filled a prescription or pursued needed care because the cost of doing so was too high.

The survey’s findings have important implications for health care reform. The open enrollment period for the Patient Protection and Affordable Care Act’s new insurance coverage options begins this October in all 50 states. People without health insurance, or those who are inadequately insured, will be able to visit an online health insurance “marketplace” to find out whether they are eligible for help. This includes new subsidies to cover the cost of a private health plan sold through the marketplace — available to people earning up to about $92,000 for a family of four — as well as a newly expanded Medicaid program for people with incomes up to about $31,000 for a family of four. States can run their own insurance marketplaces or choose a federally operated marketplace.

Last summer’s Supreme Court decision allowed states to decide whether they want to participate in the law’s Medicaid expansion, which is 100% federally financed in most states through 2016. So far, 23 states and the District of Columbia have announced that they will expand their programs, and at least five states are exploring alternative approaches to expanding their programs. About 22 states are either undecided or have decided not to participate in the expansion.

The consequences of state decisions to participate in the Medicaid expansion are significant, the survey finds. Whereas the federal government will operate insurance marketplaces in states that have chosen not to run their own, there is no full replacement program for residents of states that do not participate in the Medicaid expansion, since it was assumed when the law was written that all states would join. Therefore, most of the poorest residents in states that do not expand Medicaid — those with incomes under $23,000 for a family of four — will continue to lack affordable insurance options.

Source: Commonwealth Fund; April 26, 2013.

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