Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief—Findings from The Commonwealth Fund Biennial Health Insurance Survey of 2010

March 16, 2011

Authors: Sara R. Collins, Ph.D., Michelle M. Doty, Ph.D., Ruth Robertson, M.Sc., and Tracy Garber
Contact: Sara R. Collins, Ph.D., Vice President, Affordable Health Insurance, The Commonwealth Fund, src@cmwf.org
Editor: Martha Hostetter

Feature

Biennial Interactive Open an interactive feature to see 2010 survey data on out-of-pocket costs, medical debt, and access to care, by income and poverty level.

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Overview

Using data from the Commonwealth Biennial Health Insurance Survey of 2010 and prior years, this report examines the effect of the recession on the health insurance coverage of adults between the ages of 19 and 64 and the implications for their finances and access to health care. The survey finds that in the last two years a majority (57%) of men and women who lost a job that had health benefits became uninsured. Both insured and uninsured Americans struggled to pay medical bills and faced cost-related barriers to getting needed care. When fully implemented in 2014, the Affordable Care Act will bring relief: nearly all of the 52 million working-age adults who were without health insurance for a time in 2010 will be covered, most with subsidized premiums and reduced cost-sharing. No one who is legally present will have to go without insurance when they lose their job, and no one will be charged a higher premium because of a health problem, have a problem excluded from coverage, or be denied coverage.

Executive Summary

While the economy is beginning to recover from a deep recession, the job market has lagged painfully behind—leaving 13.7 million people unemployed, many for extended periods. For many families, the loss of income is compounded by a loss of health benefits. There are few affordable options for health insurance comparable to employer coverage, and consequently millions of adults who have lost their jobs and benefits are going without insurance. This means that already stretched family budgets are vulnerable to catastrophic losses and bankruptcy in the event of a serious accident or illness, and that families face significant financial barriers when trying to obtain needed medical care and timely preventive services. 

Using data from The Commonwealth Biennial Health Insurance Survey of 2010 and prior years, this report examines the effect of the recession on the health insurance coverage of adults  between the ages of 19 and 64 and the implications for both their finances and their access to health care. The survey of 3,033 adults, conducted by Princeton Survey Research Associates  International from July 2010 to November 2010, finds that in the last two years a majority of men and women who lost a job that had health benefits became uninsured. Adults who sought coverage on the individual insurance market over the past three years struggled to find plans they could afford and many were charged higher premiums, had a health condition excluded from their coverage, or were denied coverage altogether because of a preexisting condition. Meanwhile, Americans with health insurance had higher deductibles and consequently greater exposure to medical costs. And millions were struggling to pay medical bills, facing cost-related barriers to getting the care they need, or skipping or delaying needed care, including prescription medications, because of the cost. 

These survey findings demonstrate that the passage of the Affordable Care Act last year was  critical to the future health and well-being of working families. The survey was fielded during a  time when early provisions of the law were just being implemented; the major provisions of the law will go into effect in 2014. While the United States will surely suffer from challenging economic times in coming years, when the law is fully implemented, people will still have health insurance even if they, or a family member, become unemployed. Families with low and moderate incomes in particular will benefit from newly subsidized sources of health insurance, including Medicaid and private health plans. And no one will be charged a higher premium because of a health problem, have a health problem excluded from coverage, or be denied coverage when they seek to buy a health plan. As the law's provisions go into effect, the nation's health insurance system will move from one in which 52 million adults suffered a time uninsured in 2010 to one in which few people will be without health insurance, even during a recession.

SUMMARY OF SURVEY FINDINGS
Millions of Adults Lost Their Jobs and Health Benefits in Past Two Years

  • Nearly one-quarter (24%) of working-age adults—an estimated 43 million—reported that they and/or their spouse had lost their job within the past two years (Exhibit ES-1).Exhibit 1
  • Among respondents who reported a job loss in their family, nearly half (47%) said that either they or their spouse had received health benefits through the job that was lost.
  • Among respondents who had health benefits through their jobs and lost their jobs, nearly three of five (57%) became uninsured. Just one-quarter were able to go on to their spouse's insurance or found another source of coverage. Only 14 percent continued their coverage through COBRA.