Sheila Rustgi, Michelle M. Doty, Sara R. Collins, Jennifer L. Nicholson
A perfect storm of negative economic trends is battering working families across the United States. The federal minimum wage is now three dollars an hour lower, in real terms, than it was 40 years ago; gas and food prices are soaring; home values are declining; growth in health care costs is far outstripping income growth; and people are increasingly going without the protection of health coverage—nearly 9 million have lost their health insurance since 2000. Families are facing financial crises and are forced to make hard choices among life's necessities, often sacrificing health care and health insurance along the way.
Using data from four years of the Commonwealth Fund Biennial Health Insurance Survey—2001, 2003, 2005, and 2007—this report examines the status of health insurance for U.S. adults under age 65 and the implications for family finances and access to health care. Insurance coverage deteriorated over the past six years, with declines in coverage most severe for moderate-income families. The share of insured adults who spend more than 5 percent or 10 percent of income on health care and insurance rose across all income groups between 2001 and 2007. As a result, the number of underinsured adults (i.e., those with health coverage that does not adequately protect them from high medical expenses) climbed to 25 million people in 2007, up from 16 million in 2003.
More adults are struggling to pay their medical bills and are accumulating medical debt over time. Forty-one percent of working-age adults, or 72 million people, reported a problem paying their medical bills or had accrued medical debt, up from 34 percent, or 58 million, in 2005. An additional 7 million adults 65 and older also reported bill or debt problems. (See the companion issue brief, Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families.) This increase occurred across all income groups but families with low and moderate incomes were particularly hard hit: more than half of adults with incomes under $40,000 reported problems with their medical bills in 2007. Underinsured adults or those with gaps in their health insurance reported the highest rates.
Declining insurance coverage and rising health care costs are likely contributing to skimping on needed care. The share of U.S. adults reporting that the costs of health care prevented them from getting needed care increased from 29 percent in 2001 to 45 percent in 2007. Reports of cost-related access problems rose across all income groups and among both insured and uninsured adults.
All told, in 2007 nearly two-thirds of adults, or 116 million people, were either uninsured for a time during the year, were underinsured, reported a problem paying medical bills, and/or said they did not get needed health care because of cost.
Rising Numbers of Adults Go Without Health Insurance Coverage
Americans Are Spending Large Shares of Income on Health Care
Many Adults Have Problems Paying Their Medical Bills
High Cost of Health Care Leading Adults to Avoid Needed Medical Care
People with Gaps in Coverage and Inadequate Coverage Experience Inefficient Care
The evidence paints a vivid portrait of the U.S. health care system as experienced by families with low and moderate incomes. Health insurance is often unaffordable or unavailable, health care costs claim a growing share of household budgets, and rising numbers of people are underinsured. At the same time, medical debt mounts, people—even those with chronic illnesses—skimp on prescription drugs and needed care, individuals experience poorly coordinated health care, and adults lack confidence they will be able to afford high-quality health care in the future.
In this presidential election year, majorities of voters are voicing their dissatisfaction with the health care system. The presidential candidates and policymakers at the federal and state levels have responded with proposals and new universal coverage laws. With working families in crisis from a combination of faltering job and income security and a dramatic acceleration in the cost of basic life necessities, the time has never been more urgent for policymakers to forge ahead on solutions to the nations' worsening health insurance problem.