A Commonwealth Fund survey found that 26 percent of adults surveyed had no health insurance at some point in 2011. The reasons typically were losing a job, changing jobs or becoming ineligible for Medicaid. Fully 69 percent of respondents lacked coverage for one year or longer, while more than 50 percent had no insurance for two years or longer. Low- and moderate-income individuals were most likely to experience a long gap in healthcare coverage.
The online survey is based on responses from a random sample of 2,134 adults aged 19 to 64. Among respondents who had a gap in coverage, 41 percent lost their employer-sponsored insurance because of changing jobs, losing their job, working part-time, because they could no longer afford to pay their share of the premium, or because their employer stopped offering health insurance. Another 18 percent who had qualified for Medicaid lost coverage because they made too much money or neglected to re-enroll in the program when they were supposed to.
After losing insurance, finding coverage was difficult if not impossible. Approximately one-third who lost their insurance and tried to find new coverage within the past three years were turned down, charged a higher price, or were denied because of a pre-existing condition. Nearly 50 percent of those who lost their employer-sponsored coverage said they never bought a new insurance plan, typically because it was too expensive.
“For people who lose employer-sponsored coverage, the individual market is often the only alternative, but it is a confusing and largely unaffordable option,” Commonwealth Fund vice president Sara Collins, lead author of the survey, said. “As a result, people are going a year, two years, or more without healthcare coverage, and as a result going without needed care.”
The holes in health insurance were a primary force in President Barack Obama’s push for the Patient Protection and Affordable Care Act (ACA). According to the survey, people without health insurance often skip necessary medical care and do not get crucial preventive services such as cancer screenings. Over all, nearly 75 percent of women aged 40 to 64 with health insurance had a mammogram in the previous two years. In contrast, only 28 percent of women in that age group who did not have insurance for a year or more received a mammogram.
The Commonwealth Fund’s report proves that the ACA is helping to bridge coverage gaps for young adults because of the new provision for dependent coverage that allows young adults up to age 26 to join or stay on their parents’ health insurance plan. Nearly half (46 percent) of young adults said they had stayed on or joined a parent’s insurance policy in the last year, and about a quarter (23 percent) of parents with children under age 26 reported that they had an adult child stay on or enroll in their health plan. Young adults in higher-income families were more likely to have been helped by the new option than those in lower-income households. This is likely because adults in higher-income households are more likely to have health insurance with dependent coverage. Almost two-thirds (63 percent) of working adults knew about the provision.
Writing on the Huffington Post, Jeffrey Young says that “Nearly 50 million Americans had no health insurance in 2010, according to the latest census data. Healthcare costs, which have risen tenfold since 1980, are putting an increasing burden on families, employers, and government programs. Costs also are driving up the ranks of the uninsured and leading fewer companies to offer health benefits to their workers. From 2001 to 2011, the percentage of companies offering health benefits dropped from 68 percent to 60 percent, the Henry J. Kaiser Family Foundation reported. More than two-thirds of those who lost health insurance in 2011 cited losing their job or getting a new job without health benefits as the main reason they were uninsured, according to the Commonwealth Fund survey. Among these people, 45 percent said that they were discouraged from buying health insurance on their own because of the high cost. Sixty-two percent of the uninsured responded that finding a new health plan was ‘very difficult or impossible,’ the Commonwealth Fund said.
At the same time, many Americans don’t know exactly what the ACA contains. According to the survey, awareness of the health law’s provisions vary significantly depending on income. Fifty-four percent of respondents who had incomes below 250 percent of the federal poverty level were unaware of the under-26 provision, compared to just 25 percent at or above that line. For the high-risk pools, the totals were 63 percent and 39 percent, respectively.
“We need to do more,” said Kathleen Stoll, director of health policy for Families USA, a group that supports the health law. She described how “it takes a while for programs like these to break through.” People with pre-existing conditions are a specific challenge, because individual states run the high-risk pools with differing levels of publicity.
“The current system of health insurance in the United States has gaping holes, the effects of which have become increasingly pronounced during a weak economy,” Commonwealth Fund President Karen Davis concluded. “The Affordable Care Act is beginning to close those gaps, so that people who are already struggling can maintain health care coverage that will provide for their families’ health and help ensure their financial security.”