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It's well known that people without health insurance often put off getting care—or go without it entirely. When they do seek care, they can face enormous financial burdens from medical bills.

But another group endures similar problems: people who are underinsured. They have insurance coverage that doesn't provide adequate protection against health care costs.

A new report from The Commonwealth Fund looks at the number of people both nationally and in each state who were underinsured—meaning they lived in households that spent a high share of their annual income on medical care—in 2011–12, before the Affordable Care Act went fully into effect.
Nearly 32 Million People Were Underinsured in 2012

From 2010 to 2012, the number of underinsured grew by nearly 2 million,
from 29.9 million to 31.7 million
Rising Premiums, Reduced Benefits, and Higher Cost-Sharing in the Past Decade Have Led to More Underinsured People

By 2012, average premiums were 23%–28% of median income in 18 states, including the four most populous: California, Texas, New York, and Florida

At the same time, deductibles and cost-sharing have increased and benefits have been cut, leaving insured people with a higher share of medical bills
Underinsured and Uninsured Rates Vary Widely Across States
Low- and Middle-Income Households Are Most at Risk of Being Unable to Afford Needed Care


NOTES

Nearly 32 Million People Were Underinsured in 2012

Underinsured is defined as living in an insured household that spent 10% of income or more on medical care, excluding premiums, or 5% of income or more for households below 200% of the poverty level. Data source: March 2013 Current Population Survey.

 

Rising Premiums, Reduced Benefits

Premiums include employer and employee shares. Data sources: 2012, 2003 Medical Expenditure Panel Survey–Insurance Component; March 2004 and March 2013 Current Population Surveys for median income.

 

Underinsured and Uninsured Rates Vary Widely Across States

Underinsured is defined as living in an insured household that spent 10% of income or more on medical care, excluding premiums, or 5% of income or more for households below 200% of the poverty level. Data source: March 2012-2013 Current Population Survey (states: two-year average).

 

Low- and Middle-Income Households Are Most At Risk

Underinsured is defined as living in an insured household that spent 10% of income or more on medical care, excluding premiums, or 5% of income or more for households below 200% of the poverty level. Poor or near-poor is defined as people earning under 200 percent of the poverty level (under $22,980 for a single person; under $47,100 for a family of four). Middle income is defined as earning between 200 percent and 399 percent of the poverty level ($22,980–$45,960 for a single person; $47,100–$94,200 for a family of four).

 

 

logoSource: America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions (March 2014).

© THE COMMONWEALTH FUND 2014. Photo: Will Figg.