How a Gap in Health Insurance Coverage Affects Care

As we continue to struggle to climb out of the recession, The Commonwealth Fund is in the process of taking a two-year longitudinal look at low- and moderate-income adults to see how the group fares in terms of access to health insurance and medical care.

Two reports have already been published and a third is coming this week. The takeaway from the first report in February: Low and moderate income adults who are insured have some of the same struggles as the uninsured. Among the problems was finding a physician to even take the insurance.

It seems that lousy insurance isn't necessarily better than no insurance.

The third report, which will be released on June 8, covers one of the most popular provisions of the Patient Protection and Affordable Care Act, the one allowing young adults to stay on their parents' health insurance plans until age 26. The report is embargoed, so I can't write much now.

But last Friday's dismal jobs report helped me decide to write about the second report, which looks at what happens when Americans experience gaps in their health insurance coverage. Spoiler alert: nothing good.

While only 26%, or 48.2 million adults aged 19 to 64 years experienced a gap in their health insurance coverage in 2011, these folks often remain uninsured for a year or more. In fact, 57% were uninsured for more than two years.

The really bad news is that experiencing a gap in health insurance coverage can set a person on a slippery slope. Physicians may disappear and preventive care is often skipped. And this all happens fairly quickly. After an insurance gap of a year or more:

• Fewer than half of the respondents still had a regular doctor.
• Only 33% had their cholesterol checked in the past five years.
• About 51% had their blood pressure checked.
• Only 28% of women reported having a regularly scheduled mammogram.
• Fewer than 10% had a colon cancer screening.

Change in employment status was the leading cause of insurance gaps with 67% reporting that when they switched jobs, lost their job, or worked part-time, they lost their coverage.

COBRA benefits, which allow a former employee to continue to purchase company health insurance, are cold comfort because they're pricey. And applying for individual benefits has its own challenges:

• Some 62% said it was difficult or impossible to find affordable coverage.
• Around 38% said it was difficult or impossible to find the coverage they needed.
• About 31% reported that they were rejected, charged a higher price, or had a pre-existing condition excluded.

At the end of the day, 45% of the respondents who were uninsured and tried to purchase a plan in the individual market were not able to actually purchase one.

So where does that leave us?

The Commonwealth Fund report concludes that the "health insurance expansions and reforms in the Patient Protection and Affordable Care Act will end the gaps."

Well, that's worrisome, because sometime this month, the Supreme Court may strike down the ACA, in whole or in part. What will that mean to the millions of people who find themselves unemployed and unable to purchase health insurance?