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House Panel Looks to Help Underinsured

Janice Simmons, for HealthLeaders Media, October 16, 2009

While Congress has focused on the estimated 46 million without insurance as it looks to overhaul the healthcare system, the House Energy and Commerce Subcommittee on Oversight and Investigations on Thursday moved to include review of the estimated 25 million who are underinsured.

Subcommittee Chairman Bart Stupak (D-MI) described "underinsured" as a person who "has health insurance coverage but the policy does not adequately cover healthcare costs or high medical expenses," he said. "Underinsured individuals traditionally have high out of pocket expenses because of high deductibles and copays."

Rep. Henry Waxman (D-CA), the Energy and Commerce chairman, said that in recent years, health policies have been costing more and covering less. "The average cost of a family's premiums has risen 131% in the last decade, while average wages have risen less than a third of that amount," he said.

The committee heard from several individuals who had been thrown into bankruptcy when their policies failed to adequately cover catastrophic illnesses.

Those who are underinsured have been steadily rising—up from about 16 million in 2003, said Sara Collins, vice president of The Commonwealth Fund. She told the panel that because of higher rates of chronic illness and poorer health, older adults between the ages 50 to 64 were the most likely of any age group to be underinsured; between 2003 and 2007, the share of older adults who were underinsured increased by 60%—from 11% to 18%.

She also reported that:

  • More than one quarter (26%) of underinsured adults had a deductible of $1,000 or higher compared to 8% of insured adults who were not underinsured.
  • Another 48% reported that their health plan placed limits on the total dollar amount their plan would pay for medical care each year compared with 36% of adults who were not underinsured.
  • Another 19% reported that their health plans limited the number of times per year that they could see physicians, excluding mental health visits, compared to 11% of adults who were not underinsured.

Collins also said that an estimated 72 million adults under age 65—both with and without health insurance—reported problems paying their medical bills in 2007, and 80 million reported a time that they did not get needed health care because of cost.

Waxman said that many of the "root causes" encountered by the underinsured would be addressed in HR 3200, the House's healthcare reform bill that is still under conference committee discussion. These areas include a ban on lifetime and annual caps on the amount insurers will pay; a ban on annual limits on total out of pocket costs; and removal of deductibles or copays for preventive care.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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