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Uninsured have plateaued; underinsured are increasing

May 9, 2019

Topics: Quote of the Day

By Robin A. Cohen, Ph.D., Emily P. Terlizzi, M.P.H., and Michael E. Martinez, M.P.H., M.H.S.A.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, May 2019

In 2018, the percentage of persons of all ages who were uninsured at the time of interview was 9.4% (30.4 million). There was no significant change from the 2017 uninsured rate of 9.1% (29.3 million). A total of 18.2 million fewer persons lacked health insurance coverage in 2018 compared with 2010 (48.6 million or 16.0%).

Estimates of enrollment in HDHPs and CDHPs

In 2018, 45.8% of persons under age 65 with private health insurance were enrolled in an HDHP, including 20.4% who were enrolled in a CDHP (an HDHP with a health savings account [HSA]) and 25.4% who were enrolled in an HDHP without an HSA (Figure 11) (see Technical Notes for definitions of HDHP, CDHP, and HSA). Among those with private health insurance, enrollment in HDHPs has generally increased since 2010. The percentage of persons enrolled in an HDHP increased 20.5 percentage points, from 25.3% in 2010 to 45.8% in 2018. More recently, the percentage of those enrolled in an HDHP increased from 43.7% in 2017 to 45.8% in 2018. The percentage of persons enrolled in a CDHP almost tripled, from 7.7% in 2010 to 20.4% in 2018. More recently, the percentage of those enrolled in a CDHP increased, from 18.2% in 2017 to 20.4% in 2018. The percentage of those enrolled in an HDHP without an HSA did not change significantly from 25.5% in 2017 to 25.4% in 2018.


The silent affordability crisis facing sick people

By Drew Altman
Axios, May 8, 2019

People with major medical illnesses are having serious problems paying for the health care they need — a crisis that is flying under the radar while attention is focused on hot policy issues like the Affordable Care Act and “Medicare for All.”

The big picture: A survey by the Kaiser Family Foundation and the Los Angeles Times shows that a strikingly large share of people with serious medical conditions are struggling to pay their medical bills, often wreaking havoc with their family budgets and causing them to cut back on care.

By the numbers: Take people with employer coverage who have a chronic condition such as hypertension, asthma, a serious mental health condition, diabetes, heart disease or cancer. It’s not a small group; just over half of those with employer coverage say someone in their family is currently receiving treatment for one of these or another chronic condition.

  • 6 out of 10 people in this group report that they or a family member skipped or postponed medical care or prescription drugs they needed because of costs, or tried a home remedy instead.
  • High deductibles can make things worse: Among those with chronic conditions whose deductibles are at least $3,000 for an individual or $5,000 for a family, three-quarters report skipping or postponing some type of care.
  • About half — 49% — say they or a family member had problems paying medical bills or difficulty affording their premiums, deductibles or co-pays in the last year.

There are ripple effects on family budgets, too. A substantial share of people reported taking measures such as increasing credit card debt (28%), using up most of their savings (26%), taking an extra job (19%), and borrowing money from others (14%) to pay for health care or insurance costs.

And this was over the last year. We ask the question that way because people can more easily remember more recent experiences. It’s not hard to imagine that the share of people with chronic conditions who experience these problems over the course of a longer time period is much higher.

People who do not have serious illnesses also struggle with affordability challenges, but fewer of them do (29%). Their worries that they will get sick and not be able to pay their bills fuels health care as a political issue.

The bottom line: It may not be surprising that people who are sick have more problems; they use more care. But it is the opposite of how a compassionate and functional insurance system should work.



By Don McCanne, M.D.

Although the number of uninsured has declined since implementation of the Affordable Care Act (ACA), this year’s report can be summarized by noting that the number uninsured at the time of the 2018 analysis was 30.4 million, a statistically insignificant change from 2017 when it was 29.3 million (though this is being reported in the media as an increase in the numbers of uninsured). The point is that too many remain uninsured as the accomplishments of ACA have plateaued.

In terms of the numbers of people involved, an even greater problem is the statistically significant increase in the numbers of underinsured. The data on high deductible health plans, with or without a health savings account, demonstrate that this is a problem affecting far too many of America’s working families. In his Axios commentary, KFF’s Drew Altman describes the consequences of high deductible plans, concluding, “it is the opposite of how a compassionate and functional insurance system should work.”

Patching the Affordable Care Act or adding a Medicare public option will not fix this. Most of the perversities of our current health care financing system would remain in place. We need a bona fide, single payer, improved Medicare for All if we are going to ensure that affordable health care is there for everyone who needs it.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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