Insurance in Name Only

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The purposes of health insurance are to ensure financial access to needed care and protect against financial hardship from medical bills. Unfortunately, even for many of those who are insured, neither purpose is fulfilled. In a new column, Commonwealth Fund president Karen Davis reviews the findings of a Commonwealth Fund study published earlier this month in Health Affairs showing that 25 million Americans are underinsured — meaning they have health coverage but still have medical expenses they cannot afford.

The growing number of people with inadequate health insurance underscores the need for universal coverage that provides comprehensive benefits. As laid out in another recent Health Affairs article by Davis and colleagues Cathy Schoen and Sara Collins, a system of comprehensive, affordable coverage for all Americans is feasible. By offering more choices, including the option of enrolling in public programs, the authors' "Building Blocks" framework would provide every American with the financial security that insurance is intended to provide.

"We cannot accept a health care system in which 42 percent of Americans under age 65 are uninsured or underinsured," Davis writes. "We must pursue a workable solution that mixes private and public coverage — well before the majority of Americans find themselves with no coverage, or with coverage that has been chipped away until it no longer serves its purpose."