New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health…
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New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in
Thirty-two million people under age 65 were underinsured in the U.S. in 2012, meaning they had health coverage but it provided inadequate protection against high health care costs relative to their income, a new
Low- and middle-income families were most likely to be affected: 13 percent--4 million--of the underinsured were middle-income, earning between about
In addition, 47 million people were uninsured in 2012--a decline of nearly 2 million from 2010, likely due in large part to the Affordable Care Act's early provision to expand dependent coverage for young adults.
Before the major expansions of the ACA began to be implemented this year, a total of 79 million people under 65 were uninsured or underinsured, and therefore at risk for not being able to afford needed health care or for facing debt from medical bills in 2012. Nationally, nearly one of three (29%) people were uninsured or underinsured, ranging from 14 percent in
The Affordable Care Act's
However, millions who are poor will not have any new coverage options. In states choosing not to expand
"The vast majority of people struggling to afford health care are low- and middle- income, and exactly the people the Affordable Care Act was designed to help," said
The Affordable Care Act would also help those with high health insurance costs, the report finds. Twenty-nine million people with coverage paid more out-of-pocket for their premiums in 2012 than they would have to pay under the health reform law if they were eligible to participate in
* About 11 million who could potentially be helped by expanded
* About 12 million people with high premium costs relative to their incomes who are covered by employer-based plans have incomes too high to qualify for
* About 6 million people with high premium costs are enrolled in other public coverage programs, and may not be eligible for the new options.
The report, which analyzes premium costs, insurance status, and income state-by-state, defines people as underinsured if they have health insurance but still spend 10 percent or more of their income on medical costs, or 5 percent or more if they are low-income. Overall, states in the Northeast and Upper Midwest fared better than states in the South and West.
The report also finds:
* Twenty percent of middle-income people were uninsured or underinsured in 2012. At the state level, middle-income uninsured and underinsured individuals ranged from 9 percent of the population in
* Sixty-three percent of people living below the poverty level and nearly half (47%) of living just above poverty were uninsured or underinsured.
"The fact that nearly 80 million people in this country were at risk of not being able to get needed health care because they can't afford it, or face the prospect of burdensome debt, is evidence of the shortfalls in our system of health insurance coverage, which the Affordable Care Act was designed to address," said
Moving Forward
The authors note that many plans offered in the marketplaces require a large degree of cost-sharing, but people with low or moderate incomes who select silver-level plans will receive significant cost-sharing protections.
It will be important going forward to make certain that people understand the full implications of their choices in the new health insurance marketplaces, and in particular, that choosing low premium plans in the bronze category could result in higher total out-of-pocket expenses as a result of higher deductibles and copays. Lower premium plans may also restrict their choices of providers more than higher premium plans in the silver category.
The report concludes that reforms have the potential to change the insurance map of the country. Uninsured rates have been falling through 2013, with early indications of a continued decline in 2014 as millions have signed up for either marketplace coverage options or
Methodology
The report is based on analysis of the
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