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Survey: Recession Left Millions Uninsured but Overhaul Law Eventually Will Help

By Dena Bunis, CQ HealthBeat Managing Editor

March 16, 2011 -- With the first anniversary of the health overhaul law just a week away, the Commonwealth Fund released the results of a new health insurance survey that documents how the recession has left millions of Americans without coverage. The survey also says the new law would eventually bring relief to such families.

According to the survey, an estimated 52 million American adults were uninsured at some point during 2010, up from 38 million in 2001. The effects of the recession were clear in the numbers.

Among respondents to the survey who said someone in the family had lost a job in the past two years, nearly half—47 percent—said that either they or their spouse had received health benefits through the job that was lost. And of those who lost their health insurance because they lost their job, 47 percent became uninsured. A quarter was able to go sign on to a spouse's health benefits, and 14 percent continued their coverage through COBRA.

Karen Davis, president of The Commonwealth Fund, a nonprofit health policy research group, said that even with the 65 percent government subsidy of COBRA premiums, "the 35 percent the unemployed person has to pay is too large a share to pay with their limited income.'' And, she said in a conference call with reporters, many people laid off from smaller firms were not eligible for COBRA.

"People are facing real problems with their budgets,'' said Sara Collins, vice president of the Fund and lead author of the report. "Health care is something they're not able to afford given the rest of the demands on their budget when they lose their job.''

Most of the unemployed who searched for coverage had to look in the individual market, Commonwealth officials said, and an estimated 11 million adults said they found it difficult or impossible to find a plan that had the benefits they needed. And 16 million couldn't find a plan they could afford.

When implemented in 2014, the report said, the health law would help such workers get coverage through the state-based health exchanges.

Additionally, the survey found that it wasn't just uninsured Americans who are having problems.

"Americans with health insurance had higher deductibles and consequently greater exposure to medical costs,'' the report says. "And millions were struggling to pay medical bills, facing cost-related barriers to getting the care they need, or skipping or delaying needed care, including prescription medications, because of cost."

Thirty-two percent of working-age adults—49 million—spent 10 percent or more of their incomes on out-of-pocket costs and premiums in 2010, up from 21 percent, or 31 million adults, in 2001.

"Even with insurance coverage, with today's limits on coverage and high deductibles, it can quickly drive families into bankruptcy,'' Davis said.

Again Commonwealth officials pointed to the premium subsidies and minimum benefit standards that will be in place in the exchanges that they said will help Americans stave off medical debt and bankruptcy.

This is the fifth biennial health insurance survey the fund has done. Princeton Survey Research Associates International conducted the 25-minute telephone interviews from July 14 to Nov. 30, 2010. They surveyed 4,005 adults. The survey has a margin of error of plus or minus 1.9 percentage points.

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