Kansas City Star, June 9, 2008: More are struggling with medical expenses despite having health insurance
By JULIUS A. KARASH
The Kansas City Star
As the nation debates how to cover the uninsured, a report coming out today says insurance fails to protect growing numbers of Americans from the ravages of medical debt.
The report by the Commonwealth Fund says the number of “underinsured” adults those age 19 to 64 who struggle with medical expenses despite having health insurance rose from 16 million to more than 25 million between 2003 and 2007, an increase of 60 percent.
Those caught in the underinsurance squeeze face problems such as financial stress and going without needed care, the report says.
“Even the insured have serious gaps in coverage,” Commonwealth Fund president Karen Davis said in a teleconference Monday. “Insurance coverage is the ticket into the health care system. But for too many, that ticket does not buy financial security or genuine access to care. We need to extend affordable, effective health insurance to all.”
The report defines the underinsured as those who spend 10 percent or more of their income on out-of-pocket medical expenses, or 5 percent for those with incomes below 200 percent of the federal poverty level. Also included are those whose individual health care deductibles equal 5 percent or more of annual family income.
Forty-five percent of the underinsured reported difficulty paying bills and changing their way of life to pay their medical bills.
“In the last three years, the middle class has felt this more than we ever have before,” Corrie Edwards, executive director of the Kansas Health Consumer Coalition, a nonprofit health reform advocacy group in Topeka, said Monday.
“We are getting the life sucked out of us.”
Edwards, 40, said she struggles with medical expenses as a breast cancer survivor despite the fact that she has group health coverage through her employer. She said she pays nearly $4,000 a year out of pocket for co-insurance, co-pays and deductibles.
Edwards said she feel lucky because the coalition pays for the entire cost of her $371-a-month insurance premiums. But it still takes her 10 months out of the year to pay all her medical expenses. She said she had to borrow money from her mother about a year ago to pay for a genetic test that her insurer would not cover, even though her doctor recommended it.
“Something has to be changed,” Edwards said. “This is an election year, and I۪m hoping that this will be the year.”
The Commonwealth Fund report says underinsured adults are more likely to have insurance coverage with high deductibles and limits on visits and payments.
Yet despite more limited benefits, the underinsured pay premiums that are very similar to those paid by consumers with more generous health coverage, the report says.
The report is based on data from the Commonwealth Fund 2007 Biennial Health Insurance Survey that was conducted by Princeton Survey Research Associates International. The survey looked at 3,501 U.S. adults.
The report is at www. commonwealthfund.org and on the Web site of Health Affairs, a health policy journal, at content.healthaffairs.org.