Underinsured and Underexamined

In debates on healthcare policy, much is said about Americans who entirely lack health insurance. Less attention is given to the underinsured — people who have coverage throughout the year, but not enough to keep them from paying a lot out of pocket for medical expenses, relative to their income.

A study by the Commonwealth Fund says the number of Americans age 19-64 in this situation has risen 60 percent between 2003 and 2007 and now stands at 25.2 million. Nor is the problem limited to people whose income is at or near the poverty line. “Underinsured rates have now reached double-digit levels for families with incomes in the 200-400 percent of poverty range, solidly in the middle class,” say the report. People with income of at least 200 percent the poverty level were classified as underinsured if they spent 10 percent or more of their household income for out-of-pocket medical expenses or had per-person deductibles equal to 5 percent of income.

The report says the underinsured suffer many of the same medical-care problems as the uninsured. Fifty-three percent of the survey’s underinsured respondents said they went without needed care due to cost; 45 percent reported “difficulty paying medical bills, being contacted by collection agencies for unpaid bills or changing their way of life to pay their medical bills.”