The number of underinsured adults nationwide rose by 60% over the past four years, to 25.2 million people from 16 million, a trend that healthcare researchers called startling.
Middle-income families were especially hard hit, according to the study by the Commonwealth Fund and published online by Health Affairs. From 2003 to 2007, underinsured rates tripled among families with annual incomes of $40,000 or higher. The underinsured were defined as those who were insured all year but spent 10% or more of income on medical expenses, or 5% of total income for those with incomes under 200% of the federal poverty level. Adults with deductibles equal to 5% or more of household annual income were also included.
With premiums, copays and other out-of-pocket healthcare costs rising, the underinsured were more likely to go without needed care, even if they had a chronic condition, the telephone survey of 3,501 adults found. Some 53% of the underinsured went without needed medical care because of cost, including not seeing a doctor when they were sick or not filling prescriptions or getting recommended tests. That compared with 68% of the uninsured and 31% of the adequately insured, who reported going without care because of cost.
The underinsured look a lot like the uninsured, said Cathy Schoen, senior vice president of the Commonwealth Fund and lead author of the study.
The rise in the number of underinsured is largely because of employersespecially smaller businessesshifting more healthcare costs to workers, and because of eroding coverage on the individual market, the authors said. The availability of consumer-driven plans, such as health savings accounts, did not play a major role, as they havent gained much traction yet, the authors said. The report is available at commonwealthfund.org. -- by Rebecca Vesely
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