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PPACA Implementation Pending, Health Insurance Coverage Gaps Persist

 |  By John Commins  
   April 26, 2013

Nearly half of all working-age adults, about 84 million people, went without health insurance at some point in 2012 and another 30 million people had out-of-pocket costs that were so high, they were underinsured, a survey released by The Commonwealth Fund shows.

The results found in the survey, Insuring the Future : Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act, were not all bad, however. For example, the proportion of adults ages 19–25 who were uninsured fell from 48% percent to 41% between 2010 and 2012, reversing a near decade-long increase in uninsured rates for that age group.

"This new report reveals some good and unprecedented news; a decline in the number of young adults who are uninsured, most likely due to the [Patient Protection and] Affordable Care Act's requirement that children under age 26 be allowed to join or remain on their parents health plan," The Commonwealth Fund President David Blumenthal, MD, said Thursday at a teleconference with reporters.

"But overall, the survey shows the continuation of the bad news that sparked the moves to reform our dysfunctional healthcare system. To begin with, large numbers of uninsured Americans—millions—are facing problems getting the help they need. They are financially squeezed by the burdens of high deductibles and far too many Americans are hampered by medical debt. These findings point clearly to the need to move forward with implementation of the law," Blumenthal says.

The percentage of people who were uninsured, underinsured, or had gaps in their health coverage grew steadily between 2003 and 2010, with the number of underinsured nearly doubling from 16 million in 2003 to 29 million in 2010. Between 2010 and 2012, however, the numbers of underinsured adults leveled off, growing to 30 million, the survey found.

That is partly because of slower healthcare cost growth and lower overall health spending by strapped consumers. However, provisions in the PPACA that require insurers to cover preventive care at no cost to patients are also making healthcare more affordable for many consumers, the report says.

The telephone survey was conducted in English or Spanish by Princeton Survey Research Associates International from April 26 to Aug. 19, 2012 and included a random, nationally representative weighted sample of 4,432 adults ages 19 and older.

Pollsters projected that 80 million people did not go to the doctor or did not get a prescription filled in 2012 because they couldn't afford it. Medical debt also continues to burden many households, with 41% of working-age adults, an estimated 75 million people, having problems paying their medical bills, up from 58 million in 2005.

Nearly one in five people were contacted by a collections agency for unpaid bills, and 16% had to make lifestyle changes because of medical bills. More than 40% of survey respondents who reported having trouble with medical bills, an estimated 32 million people, had a lower credit rating because of unpaid bills and 6%, an estimated 4 million people, declared bankruptcy because of their bills.

Major provisions of the PPACA do not take effect until 2014, but the survey estimated that 87% of the 55 million people who were uninsured at some point in 2012 would be eligible for some form of subsidized insurance either through the expanded Medicaid rolls or through the health insurance exchanges.

In addition, as much as 85% of the 30 million underinsured adults in 2012 might be eligible for either Medicaid or subsidized health insurance with reduced out-of-pocket costs under the PPACA.

The survey also found that:

  • Nearly three-of-four working-age adults with incomes of less than $14,856 a year for a person or $30,657 for a family of four — an estimated 40 million people — were uninsured or underinsured;
  • Nearly 60% of adults with incomes between $14,856 and $27,925 for an individual or between $30,657 and $57,625 for a family of four — or 21 million people — were uninsured or underinsured;
  • Uninsured adults were less likely to receive recommended preventive care. Only 48% of women who were uninsured during the year received a mammogram compared to 77% of those who were well insured all year.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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