Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Senate Help Committee Probes Problem of Underinsurance

By Melissa Attias, CQ Staff

February 25, 2009 -- Many Americans with health insurance are forgoing needed medical care because of costs, witnesses said during a Senate Health, Education, Labor, and Pensions Committee hearing on underinsurance.

"When people have cost concerns, they delay care even when it's really important to get it," said Diane Rowland, executive vice president of The Henry J. Kaiser Family Foundation and executive director of The Kaiser Commission on Medicaid and the Uninsured.

Sen. Jeff Bingaman, D-N.M., who chaired the hearing held Tuesday, defined underinsurance as "an insured individual whose family medical expenditures total 10 percent or more of their income or whose health plan includes deductibles greater than 5 percent of income."

According to Cathy Schoen, senior vice president of The Commonwealth Fund, the number of underinsured adults increased by 60 percent from 2003 to 2007. Schoen said an estimated 25 million adults under age 65 were underinsured in 2007 and more than half of them went without recommended treatment, medication or follow up care or did not see a doctor when they were sick. In comparison, two thirds of the uninsured went without treatment.

"It's getting harder to tell the underinsured and the uninsured from each other," Schoen said.

Rowland said the experience of many cancer patients exemplifies the holes in health care coverage. Despite the fact that they have a life-threatening disease, Rowland said that 5 percent of insured cancer patients say they delayed or decided against care because of costs.

"High levels of cost-sharing and caps on covered benefits can compromise the level of protection health insurance provides and lead to both reduced access to needed care and serious financial burdens and medical debt," she said.

Rowland also said that three in 10 non-elderly adults with health insurance reported problems paying medical bills in October 2008.

Congress should expand comparative effectiveness research to lower costs, said Gail Shearer, director of health policy analysis of the Consumers Union. Shearer said the research would increase the knowledge base for making treatment and coverage decisions and cut health care costs.

"The underlying problem is that health care costs are high," Shearer said. "People were hurting, but as of October the level of hurt has just expanded exponentially."

Grace-Marie Turner, president of the Galen Institute, said that employers should provide flexibility in benefit offerings to keep health care insurance affordable. All but 5.5 percent of Wal-Mart employees have health insurance compared with a nationwide uninsurance rate of 18 percent in part because the company provides their employees with many health insurance options, Turner said.

Turner also recommended the use of Health Savings Accounts, which allow individuals to combine health insurance covering large medical expenses and preventive care with a tax-free health spending and savings account for routine health expenses.

In addition, Turner said the success of Medicare Part D exemplifies how increasing competition among health care providers can improve quality and lower costs.

"Companies have been forced to provide comprehensive and affordable coverage or they're going to be left out of the market," Turner said.

Schoen said dedicating attention to insurance design is essential to providing affordable health care coverage. Among other measures, policy makers should provide income-related premiums, set a minimum floor and standard for health insurance with benefits and establish lower cost sharing and ceilings on out-of-pocket expenses for low-income families, she said.

Publication Details