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CDC: Americans Uninsured at Least Part of the Year on the Rise, Harming Public Health

By John Reichard, CQ HealthBeat Editor

November 9, 2010 —The number of Americans—including those in the middle class—who have had periods without health coverage has risen considerably in recent years. That has led people with hypertension, diabetes and asthma to skip care, thus increasing their odds of developing costly complications, according to the findings of an extensive government survey released on Tuesday.

An estimated 59.1 million Americans in the first quarter of 2010 were uninsured for at least part of the year before they were interviewed, according to the National Health Interview Survey. U.S. Census Bureau officials interviewed 90,000 people in 35,000 households.

The analysis was released by CDC as part of its "Vital Signs" reports, which highlight a different public health issue each month.

The 59.1 million figure represented an increase of 400,000 compared with 2009 and 2.7 million compared with 2008, according to CDC.

The lack of coverage strikes many in the middle class, Centers for Disease Control and Prevention Director Thomas Frieden said in a telephone press briefing Tuesday. Among people 18 to 64 years old with family incomes two to three times the federal poverty level, 9.7 million, or 32.1 percent, said they'd had a period without insurance during the previous year. Among people in that age group with incomes three to four times the poverty level, 5.2 million, or 20.6 percent, reported a period of no coverage in the prior year.

The data also showed that the number of Americans without coverage for more than one year grew by 1.3 million in the first quarter of 2010 to a total of 30.4 million. The comparison was with 2009 figures.

"Gaps in insurance coverage are associated with delaying or forgoing health care, irrespective of family income level," the analysis found. "These findings are particularly important for persons with chronic diseases. Approximately 40 percent of persons in the United States have one or more chronic disease, and continuity in the health care they receive is essential to prevent complications, avoidable long-term expenditures, and premature mortality."

People between 18 to 64 without insurance for at least a year were much more likely to skip medical care. But that problem also occurred frequently among those who only went for one to three months without coverage in the prior year.

Those without coverage during the prior year were seven times as likely (27.6 percent versus 4 percent) to forego needed health care because of cost compared with those who were continuously uninsured. They were six times as likely to forego needed care if they had hypertension or diabetes, and five times as likely if they had asthma.

Skipping care for hypertension can lead to stroke and costly rehabilitation, Frieden noted in the briefing. Skipping it for asthma can lead to hospitalization. And for diabetes, the result could be organ failure, blindness, and amputation.

Those with a one-to-three month gap in coverage during the preceding year were three times as likely (26.5 percent versus 7.1 percent) to skip care because of cost. And they were three times as likely to skip needed care if they had hypertension, diabetes or asthma.

The findings illustrate the importance of continuous coverage, the report said, noting that the number of Americans with such coverage is expected to grow under the health care overhaul law. But sharp increases in coverage are increasingly uncertain with Republicans opposed to the law gaining strength in Congress and court challenges of its constitutionality.

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