25 million Americans who are but aren't....are you one of them?

From John Curry, June 16, 2008

Subject: 25 million Americans who are but aren't....are you one of them?‏

Editorial from Ohio.com, June 16, 2008

Barely insured

Want more evidence of America's flawed health-care system? The 25 million insured citizens who don't get the care they need

The plight of the growing numbers of Americans (estimated at more than 49 million this year) who have no health insurance has been a staple for years in the debate about fixing the health-care system. Overlooked, all too often, are the problems confronting the underinsured, those who do have health insurance but find their coverage leaves them with very high out-of-pocket expenses.

A new study by the Commonwealth Fund published last week gives further indication of the impact of the flaws inherent in the current system of health care. Analyzing data from 2007, the study estimated that 25 million American adults between the ages of 19 and 64 are underinsured.

An update of a 2003 study, the new report found the number of underinsured (people spending 10 percent or more of their annual income on out-of-pocket medical expenses) increased 60 percent over the four years. Among adults earning more than $40,000 a year, the rate of underinsurance nearly tripled. The number of adults with adequate health insurance year-round dropped by 10 percentage points between 2003 and 2007.

In 2007, the study concluded, about 42 percent of adults in the country either had health coverage that was inadequate or none at all.

Simply put, the crisis of inadequate coverage is rapidly creeping up the income ladder, along with related concerns about access to care when it is needed and the cost burden on families.

As this study and others have noted, the underinsured are only marginally better off than those who lack coverage. The underinsured are as likely as the uninsured to delay medical visits and care for chronic conditions until their problems are acute. They are just as likely to skip expensive prescription medications, diagnostic tests and referrals to specialist care. Medical expenses cut deep into family finances, threatening financial stability and forcing difficult choices that affect other obligations such as housing and education.

Cost-sharing policies (such as co-payments and deductibles) are making coverage less affordable for more middle-income households. But as the Commonwealth Fund correctly points out, policies that restrict the content of the benefits package, what is covered under the insurance plan, equally restrict access to care. Increasingly, the market for health insurance defines ''affordability'' by limiting coverage, often excluding pre-existing conditions or vision and dental care or capping benefits for chronic illnesses.

The steady rise in underinsurance underscores the stark realities driving the debate over health insurance reform. At issue in this instance is that the availability of coverage is not enough to ensure effective medical care for a growing percentage of Americans.