"The financial health insecurity that comes from being underinsured is substantial and puts people's health and well-being at risk," says The Commonwealth Fund President David Blumenthal, MD.
High-deductible health insurance plans have been touted as a means to expand coverage to millions of people who otherwise could not afford it.
New reports out this month suggest that high-deductible non-group plans are not a silver bullet, however, and that while the premiums may be affordable, the costs of accessing care remains prohibitively high.
A survey released this week by The Commonwealth Fund found that 31 million adults ages 19–64 with health coverage were "underinsured" in 2014, and that oftentimes these underinsured people skimped on care because it was too expensive.
"The financial health insecurity that comes from being underinsured is substantial and puts people's health and well-being at risk," The Commonwealth Fund President David Blumenthal, MD, said at a news conference Tuesday. "If health insurance costs continue to be shifted to consumers this insecurity will deepen."
Sara Collins, the lead author of study, and vice president, Health Care Coverage and Access at The Commonwealth Fund, says "underinsured" status considers an insured adult's out-of-pocket costs during a year of coverage and the plan deductible. Premiums are not factored.
David Blumenthal, MD
"Someone is underinsured if their out-of-pocket costs excluding premiums over the 12 prior months are equal to 10% or more of household income," Collins says, "or if their out-of-pocket costs excluding premiums are equal to 5% or more of household income if their income is under 200% of the federal poverty level, which is about $23,000 for an individual and $47,000 for a family of four, of if their deductible is 5% or more of household income."
Collins says that after nearly doubling between 2003 and 2010 the number of underinsured adults held constant between 2012 and 2014.
"However, growth and the proliferation and size of deductibles threatens to increase underinsurance in the years ahead," she says. "Underinsured adults tend to skimp on needed healthcare and many are accumulating medical debt that is damaging their credit ratings and depleting their savings."
The effects of group coverage under the Patient Protection and Affordable Care Act were not factored into The Commonwealth Fund's report because people insured for a full year in the survey had coverage that began before the PPACA's major coverage expansion going into effect.
"The Affordable Care Act improves the quality of insurance coverage for people who lack job-based health benefits, but many marketplace plans and individual marketplace policies come with high deductibles," Collins says.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.