Minority Americans are also at high risk for being uninsured. Using data from the 2005 Biennial Health Insurance Survey, Fund staff Michelle M. Doty, Ph.D., and Alyssa L. Holmgren found that 62 percent of working-age Hispanics and 33 percent of African Americans were uninsured for some time during 2005, compared with 20 percent of their white counterparts.⁽⁸⁾ The researchers found that Hispanic adults are particularly disconnected from the health system: compared with whites, they are substantially less likely to have a regular doctor, to have visited a doctor in the past year, or to feel confident about their ability to manage health problems.

Low-wage workers and their families, meanwhile, comprise the largest share of the uninsured. Uninsured, low-income workers and their spouses nearing retirement are particularly vulnerable, given the high rates of chronic illness in this group. In an analysis of the Commonwealth Fund Survey of Older Adults, Collins and colleagues found that many older adults in working families (ages 50 to 64) go through periods without coverage. More than half of those in families with incomes under $25,000, and one-third of those in families with incomes between $25,000 and $40,000, had been uninsured for at least some time since turning 50.⁽⁹⁾ More than half of uninsured older adults in working families reported they were not able to get needed care because of the cost, had problems paying medical bills, or were paying off medical debt.

By the time they enroll in Medicare, many older adults who had previously been uninsured are hampered by health problems that have gone untreated and now require intensive and costly care. With Fund support, John Ayanian, M.D., and colleagues at Harvard Medical School are assessing how this phenomenon affects costs and use of health services in Medicare. The project will inform policymakers about the potential gains of expanding Medicare coverage to adults under 65 and consider whether the cost of such an expansion would be offset by savings from having a healthier Medicare population.