By Lauren Bikoff, MLS
Reasons for instability of coverage include coverage gaps, high out-of-pocket costs and deductibles.
In the first half of 2020, 43 percent of working-age adults did not have stable health insurance coverage, according to recent research from the Commonwealth Fund. The Biennial Health Insurance Survey noted that the reasons for the instability varied—some were uninsured at the time of the survey (12.5 percent), some experienced a coverage gap (9.5 percent), and some were insured for the full year but had such high out-of-pocket costs or deductibles relative to their income that they were effectively "underinsured" (21 percent).
The survey found the following:
- People of color, small-business workers, people with low incomes, and young adults had the highest uninsured rates. More than one-third of Latino adults, small-business workers, and adults with low incomes were either uninsured or spent some time uninsured in the past year.
- The growth in the underinsured since 2010 has been driven by employer health plans with inadequate coverage. One-quarter of adults with employer plans were underinsured. In 2010, only 7 percent of people in private plans, either employer or individual market, had deductibles that amounted to 5 percent or more of income. This is a key indicator of underinsurance. By 2016, the share had doubled (15 percent). Between 2010 and 2020, the share of privately insured adults with deductibles of $1,000 or more doubled—from 22 percent to 46 percent.
- Many U.S. adults struggle to pay their medical bills, though people with inadequate coverage tend to have more problems. One-quarter of working-age adults with adequate coverage for the full year reported medical bill problems or debt in the past year. Half of adults who spent any time uninsured or underinsured reported problems paying medical bills or that they were paying off medical debt over time. Blacks were significantly more likely than whites to report problems with medical bills (45 percent vs. 35 percent).
- Medical debt leaves people with lingering financial problems. Among adults who reported any medical bill or debt problem: 37 percent said they had used up all their savings to pay their bills; 40 percent had received a lower credit rating as a result of their medical debt; and 26 percent were unable to pay for basic necessities such as food, heat, or their rent.
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