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Uninsured Crisis Moves Up the Income Ladder

America's uninsured crisis disproportionately affects lower-income working families. But new survey data show that moderate-income Americans are increasingly going without health coverage as well.

According to a report prepared for The Commonwealth Fund's Commission on a High Performance Health System, Gaps in Health Insurance: An All-American Problem, two of five (41%) working-age Americans (ages 19 to 64) with annual incomes between $20,000 and $40,000 were uninsured for at least part of the past year. This represents a dramatic and rapid rise from 2001, when just over one-quarter (28%) of this group was uninsured.

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Lower-income adults are still more likely to be lacking health coverage. And the vast majority of the uninsured are in working families: of the estimated 48 million working-age adults uninsured during the year, 67 percent were in families in which at least one person was working full-time.

"The jump in uninsured among those with modest incomes is alarming, particularly at a time when our economy has been improving," said Commonwealth Fund President and report coauthor Karen Davis.

The study also found that a startling proportion of adults—21 percent—currently has medical debt it is paying off over time. But it's not just the uninsured who are having problems with their bills: nearly two-thirds (62%) of adults with medical bills or debt problems said that they or their family member were insured when they incurred the debt.

Gaps in insurance coverage, meanwhile, are forcing many Americans with chronic health conditions, such as diabetes and hypertension, to make some tough choices. Nearly 60 percent of chronically ill adults who had a time uninsured in the past year went without medications, or skipped doses, because they could not afford them. Adults with a chronic condition, moreover, were more likely to go to an emergency room if they lacked health coverage than if they had insurance.

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Preventive care is another area where the uninsured cut back, including cancer screenings and periodic checks for high cholesterol and high blood pressure, all of which are recommended in national guidelines. For example, only 18 percent of adults ages 50 to 64 who were uninsured at the time of the survey had a colon cancer screening in the past five years, compared with 56 percent of insured adults.

"These findings paint a disturbing picture of the day-to-day impact of being uninsured on the physical as well as financial health of millions of Americans," said Sara R. Collins, Ph.D., a Fund senior program officer and the report's lead author. "The uninsured are more likely to go without preventive care or screening tests that could prevent more serious and costly health problems."

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