UNDERinsured: Have Health Insurance & Still Screwed (Health Care Thursday)
Thu Mar 22, 2007 at 05:22:47 AM PDT
Sure we have all heard about the uninsured, the 46+ million and growing... but hey "I have insurance" you say, "so I am okay."
Or maybe not...
What does "having health insurance" really mean?
You have to ask yourself the following questions:
- How expensive is the premium, or whatever part of buying or sharing the cost of coverage that you have to pay?
- How high is the deductible, the amount of the bills that you have to pay all of, before the insurance begins to pay?
- Is it one deductible per year, or is it a separate deductible for each condition (don't have two or more different sicknesses or diseases).
- Even after the deductible, does the plan pay 100% of costs or only some percentage of the bill (perhaps 80%; leaving you with 20% forever).
- Is there a maximum that the insurance will cover up to (a cap), after which you are on your own again?
- Is there an annual cap? Is there a lifetime cap?
- Does your insurance cover prescriptions (at least 10% of private insurance does not at all)?
- Does your insurance cover dental care (29% of private insurance does not at all)?
- Does your insurance cover eye care (37% of private insurance does not at all)?
- Do you have insurance all the time, all year, every year, or are you sometimes insured and sometimes uninsured?
- What percentage of claims that are filed, does the insurance company initially reject or refuse to pay in full? How much paperwork and hassle do you have to go through to get them to cover what you are owed. And were you still screwed in the end, compared with what they initially assured would be covered?
If, despite officially "having insurance" you still, literally cannot afford to be sick then you are underinsured.
Depending on the exact definition used, somewhere between 12% to 18% of Americans ages 19-64 are UNDERinsured.
First, a few commnts about interpreting health insurance statistics:
- The 47 (or 45 or 46) million uninsured is just for those without insurance at the point in time when the question is asked. But since many people go on and off being covered, the number is much greater if you ask, "over the year was there anytime when you were without insurance." The number is about 50% higher over one year, and 85 million are uninsured at some point over a 4 year period or twice the point estimate usually cited. This contributes to additional health and economic insecurity beyond the usually quoted uninsurance figure."
- Anytime you see health insurance statistics, check if the population being considered is everybody, including children for whom coverage under Medicaid/SCHIP is more readily available and/or adults over the age of 65% where everybody has Medicare eligibility. Very often the statistic will be for persons ages 19 to 64.
Survey data from the Kaiser Foundation (.PDF) in 2002 showed that among persons who were insured:
- 24% of insured families spent $2,000 or more out-of-pocket expenses on health care.
- 18% reported postponing seeking care due to costs
- 15% had problems paying medical bills
- 10% had needed a prescription filled, but did not get it
- 8% were contacted by a collection agency about medical bills
- 6% needed medical care but did not get it.
Another study in 2005 by researchers for the Commonwealth Fund, used the following definition for adults 19-64 years old (that is people too old for Medicaid and too young for Medicare):
You were UNDERinsured, if you did have insurance for the entire year, but also had any of:
- Annual out of pocket expenses amount to 10% or more of income; or
- If your incomes was under 200% of poverty level (low income) and out of pocket amount to 5% or more of income;
- Health plan deductibles were 5% or more income.
Using that definition, they found that:
- 12% of adults who had insurance all year, met the criteria for underinsured.
- The number was much higher, 73%, for adults with incomes under 200% of the poverty level and had insurance were still underinsured.
- Perhaps most frighteningly, among persons with chronic disease or reporting poor or fair health, 43% (more than 3 times the average) were underinsured by this definition.
- 37% of adults were having difficulty paying medical bills or had accrued medical debt.
Comparing those with no insurance to those who were Insured and Underinsured, they found that people reporting that they:
- Went without needed care due to costs (did not fill prescription; did not see specialist when referred; skipped recommended medical test, treatment or follow-up):
- Insured = 25%
- Underinsured = 54%
- Uninsured = 59%
- Contacted by a collection agency about medical bills:
- Insured = 11%
- Underinsured = 46%
- Uninsured = 44%
- Changed way of life to pay medical bills:
- Insured = 7%
- Underinsured = 35%
- Uninsured = 28%
In other words, being underinsured makes you a lot like being uninsured.
Medical Bankruptcy:
The 2005 study out of Harvard showed that:
- Half of all bankruptcies in the United States are due to medical expenses
- From 1980 to 2001 the annual number of bankruptcies tripled overall, while those due to medical expense went up 23 fold.
- 76% of people who had a medical-related bankruptcy had health insurance when they first became ill.
- 38% of those who filed for bankruptcy lost their health coverage at least temporarily by the time they had declared bankruptcy
- Most of those who filed for bankruptcy because of medical costs were middle-income homeowners, the study indicates
- For people filing bankruptcy, out-of-pocket medical costs averaged $13,460 for those who had health insurance, compared with an average of $10,893 for the uninsured.
- The highest costs — $18,005 on average — were incurred by people who had private health coverage at the beginning of their illness but later lost it, according to the study.
- For patients with cancer, average out-of-pocket costs were $35,878.
- Employer-sponsored health insurance does not shield families from high medical costs because an illness can lead to job loss and loss of health coverage.
- people who cited medical bills as a cause for filing bankruptcy were more likely than others to have experienced a gap in health coverage because of costs or because they switched to a new plan and then lost coverage because of pre-existing medical conditions.
- 33% of those who filed for bankruptcy because of medical costs said they still have difficulty paying bills, such as mortgages, utilities and rent.
Some Political Implications:
- Underinsured is an underemphasized part of the health insurance crisis in America
- Emphasizing the underinsured bolsters people's understanding of the real problem, and promotes support for true universal health insurance by pointing out how vulnerable we all are, even those who "have insurance."
- Most current health care proposals such as the "Mandated Plans do nothing for the underinsured, because they continue to rely on the private sector plans that deliberately provide such incomplete coverage.
- By going the single payer route, such as with "Medicare for all", and cutting out the unnecessary private for-profit insurance industry that only competes in how they can not provide coverage (what they call medical loss; what we call coverage for care) we fully cover not onlyh the uninsured but also the UNDERinsured.
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HR-676, one example of the "Medicare for All" approach, would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident: It would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing aids, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.
The bill garnered 78 co-sponsors in the last Congress, more than any other reform proposal, including the chairman of Ways and Means (Rangel, D-NY) and the chair of Ways & Means health subcommittee (Pete Stark, D-CA). At least three of the newest members of Congress made support for single payer national health insurance a key issue in their campaigns. Senator Kennedy has been the Senate sponsor in past years.
HR 676 has been endorsed by 248 union organizations in 40 states including 65 Central Labor Councils and Area Labor Federations and 17 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO & MN), as well as many other civic and religious organizations.
So, here is what YOU can DO now:
- Ask your congressperson to sign-up as a co-sponsor of HR-676!
- You can look-up your elected officials here
- Get any organization you belong to -- civic, religious, labor, community, etc. to pass an HR-676 endorsement resolution:
- Here is how to do that via Physicians for a National Health Program.
- or here here if you prefer via a non-physician group.
Just do it!
I will be on vacation next week, so the next health care thursday will be April 5. Stay healthy.
