The Uninsured

Who are the Uninsured?

  • In 2006, one in every six Americans under the age of 65 did not have health insurance. That’s 46.5 million people.  Two-third’s of the uninsured are individuals and families who have income that is less than the federal poverty level.
  • Over eight in ten of the uninsured come from working families - more than 70% from families with one of more full-time workers and 11% from families with part-time workers.
  • Because of the high cost of health insurance, the poor and near-poor are the most likely to be uninsured.
  • Adults are more likely to be uninsured than children, but the number of uninsured children in 2006 was 8.7 million, or 11.7% of all children in the U.S.
  • Young adults are the least likely of any age group to have health insurance.
  • Almost 65% of non-elderly uninsured adults did not attend college, making them less able to get higher-skilled jobs that typically provide health coverage.
  • Minorities are much more likely to be uninsured than whites.
  • The majority of the uninsured (78%) are native or naturalized U.S. Citizens.
  • The uninsured tend to be in worse health than the privately insured.
  • The majority of uninsured adults (75%) have gone without coverage for a period of at least one year.

Why is the number of uninsured people increasing?

  • The number of uninsured continues to grow steadily.  The economic downturn in 2001, coupled with rapidly rising health premiums (12%increases annually), started a prolonged decrease in employer-sponsored coverage.  A third of the firms in the U.S. do not offer health coverage to employees.  Nearly 266,000 companies dropped their health coverage between 2000 - 2005.
  • Even when employees are offered coverage on the job, many times they cannot afford their own portion of the premium.  Employee spending for health insurance coverage has increased 143% between 2000 - 2006.
  • Only 7% of the unemployed can afford to pay for COBRA health insurance when they lose or quit a job.  COBRA premiums average almost $700 a month for family and $250 a month for individual. 

How does lack of insurance affect access to health care services?

  • The uninsured are far more likely than those with insurance to report problems getting needed medical care: 25% of uninsured adults forego care because of the costs.
  • The uninsured have no regular or usual source at which to obtain medical care.
  • Anticipating high medical bills, many of the uninsured are not able to follow recommended treatments.
  • When the uninsured are hospitalized, they are more likely to receive fewer diagnostic and therapeutic services and also are more likely to die in the hospital than are insured patients. 
  • The uninsured are less likely to receive timely preventive care. For example, non-insured cancer patients are generally diagnosed in later stages of the disease and die earlier than those with insurance.
  • Having insurance improves health overall and could reduce mortality rates for the uninsured by 10-25%.

How do the uninsured pay for medical care?

  • The uninsured are almost three times as likely as those with health coverage to live in a household that is having difficulty paying monthly expenses as basic as rent, food and utilities.  Medical bills can mount up quickly and have a serious financial impact on an uninsured family.
  • Medical bills for the uninsured have a large impact on a person’s debt and credit history if not able to be paid.
  • The uninsured are increasingly required to pay “up front” before services will be rendered.  If they are unable to pay up front cash, they can sometimes negotiate a payment schedule, pay with credit cards, or can be turned away.
  • Most of the uninsured do not receive health services for free or at a reduced charge.  Hospitals frequently charge uninsured patients two to four times what health insurers and public programs actually pay for hospital services.  In 2004, the rates charge to many uninsured and other “self-pay” patients for hospital services were often 2.5 times what most health insurers actually paid and more than three times the hospital’s Medicare-allowable costs.
  • When the uninsured are unable to pay for care they receive, that uncompensated care is paid for through federal, state, and private funds.  Yet this funding has not kept pace with the rising numbers of uninsured and increasing medical costs.
  • The cost of uncompensated care was estimated to be about $41 billion in 2004.  Government spending available to pay for the care of the uninsured in 2004 was $34.6 billion.
  • Medicaid is the nation’s major public health insurance program for low-income Americans, providing coverage based not only on income levels, but also eligibility categories.
  • Medicaid covers four main groups of non-elderly, low-income people: children, pregnant women and people with disabilities.

Does health insurance improve health?

  • There is a substantial body of research the supports the hypothesis that having health insurance improves health and that better health leads to higher labor force participation and higher income.  This is a general statement that is not always the case. There typically is a connection between one’s health and health insurance.
  • A recent study looked at whether insured individuals who experienced a health shock caused by an unintentional injury or a new chronic condition experienced better medical care than those without insurance.  The conclusion pointed to the fact that uninsured individuals reported receiving less medical care and poorer short-term changes in health than those with insurance.  They have greater difficulty obtaining recommended medical care and it takes them longer to return to full health (if they do at all).
  • When it comes to new chronic conditions, the uninsured are more likely to report no longer being treated, when most chronic conditions require care over an extended period.  They also have a greater tendency to rely on emergency care, making the care more episodic and lacking continuity. 

Sources:

Anderson, Gerald. (June 2007). From ‘Soak the Rich’ to ‘Soak the Poor’: Recent Trends
in Hospital Pricing. Retrieved from http://content.healthaffairs.org/cgi/content/abstract/26/3/780

Facts on Health Insurance Coverage. (2008). The National Coalition on Health Care.
http://www.nchc.org/facts/coverage.shtml

Hadley, Jack. (July 2008).  Insurance Coverage, Medical Care Use, and Short-Term
Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition.  Retrieved from http://jama.ama-assn.org/cgi/content/full/297/10/1073

Kaiser Family Foundation Document: www.kff.org

The Uninsured: A Primer. October. (2007) 
http://www.kff.org/uninsured/7451.cfm

State Health Facts. April (2007)  www.statehealthfacts.org

The Uninsured and Their Access to Health Care. (October 2007).
http://www.kff.org/uninsured/1420.cfm