More adults going without medical care because of costs

A greater percentage of working-age adults forgo doctor visits, tests and medication, a study finds.

By Charles Fiegl — Posted March 28, 2011

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More working-age Americans are going without health insurance and not seeking physician care for injuries or illness because they can't afford it, according to two new studies released in March.

A report by the New York-based Commonwealth Fund found that the portion of patients delaying medical treatment in the last year is trending upward. Findings from the group's biennial health insurance survey in 2010 show that an increasing percentage of working-age adults skipped office visits, medical tests and prescriptions because of costs.

Many survey respondents are going without health coverage after losing a job during the economic recession, said Sara Collins, an author of the Commonwealth Fund study.

"This is largely because there are few affordable options for health insurance when job-based coverage is lost," she said. "We found that more than 70% of an estimated 26 million adults who tried to buy coverage in the individual market in the past three years reported difficulties finding affordable plans that met their needs. Nine million were turned down, charged a higher price or had a condition excluded from their coverage because of a preexisting condition."

An estimated 43 million working-age adults reported that they or their spouses lost their jobs within the past two years, according to the study. Among those reporting a job loss, nearly half said they initially lost health benefits, too. Only 14% of those people continued coverage through COBRA, while a quarter were able to go on their spouses' insurance plans or find coverage elsewhere. This meant 57% of those losing both a job and health coverage were added to the ranks of the uninsured.

The number of uninsured adults rose during the last decade to an estimated 52 million, or 28% of the working-age population, from 38 million, or 24%. The rate of young adults and minorities without coverage is relatively high -- 44% of 19- to 29-year-olds, 51% of Hispanics and 37% of blacks.

The study found that those with insurance are paying more for their coverage. Premiums in employer plans increased 41% between 2003 and 2009, and deductibles rose 77%. Nearly half of working adults spent at least 10% of their income on out-of-pocket costs and premiums in 2010.

The organization Families USA in Washington, D.C., conducted a similar study with the Lewin Group, based in Falls Church, Va., and found out-of-pocket costs are rising and becoming a burden for more Americans. A cap under the new health system reform law on what consumers will be expected to pay will curb spending increases starting in 2014, the group said. In the meantime, the study estimates that 15 million Americans younger than 65 will be spending a combined $24.7 billion above those cap levels this year.

"These families are terribly vulnerable to financial devastation caused by unexpected illness or injury, and they generally face only bad alternatives, including massive credit card debt," said Ron Pollack, executive director of Families USA.

In 2011 dollars, the upcoming cap is $5,950 for individuals and $11,900 for families with incomes between 200% and 300% of the federal poverty level, Pollack said.

The Commonwealth Fund estimates that nearly a third of non-Medicare adults had problems paying medical bills in 2010 and that 16% were contacted by a collection agency for unpaid medical bills.

Primary care shortages could interfere

National health system reforms are expected to provide greater access to insurance coverage by adding 16 million more Americans to Medicaid rolls by 2019. But the federal government will be expanding Medicaid even though only 42% of primary care physicians accepted new Medicaid patients in 2008, according to a March report by the Washington, D.C.-based Center for Studying Health System Change.

States in the South and the mountain West might have difficulty caring for these patients, according to the report. These regions tend to have lower amounts of primary care physicians per capita.

The new law will attempt to encourage physicians to accept new Medicaid patients by increasing primary care payments to equal Medicare rates in 2013 and 2014. However, the report found that rate increases "will have much less impact in states with a relatively small number of [primary care physicians] accepting Medicaid patients now, because many of these states already reimburse primary care at rates close to or exceeding 100% of Medicare." These states are Alaska, Arizona, Idaho, North Carolina, Oklahoma and Wyoming, where there are less than 11.5 primary care physicians per 10,000 residents.

The Northeast has the most physicians per capita, about 15 or more primary care physicians per 10,000 residents, but the region will see modest increases in Medicaid enrollment, the study concluded.

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Money troubles mean less care

The recent recession has prompted more patients to forgo needed medical care, according to a recent study by the Commonwealth Fund. The percentage of adults age 19-64 who reported a cost-related access problem during the year has increased over the last decade.

Access problem 2001 2005 2010
Had a medical problem but did not visit doctor or clinic 14% (23 million) 24% (41 million) 26% (49 million)
Did not fill a prescription 18% (29 million) 25% (43 million) 26% (48 million)
Skipped a recommended test, treatment or follow-up 11% (18 million) 20% (34 million) 25% (47 million)
Did not get needed specialist care 17% (27 million) 17% (30 million) 18% (34 million)

Source: "Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief -- Findings from the Commonwealth Fund Biennial Health Insurance Survey of 2010," The Commonwealth Fund, March (link)

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Medicaid pay commission releases first report

The Medicaid and CHIP Payment and Access Commission, known as MACPAC, released its first report to Congress in March. The commission was established in 2009, and its authority expanded a year later under the health system reform law.

The inaugural report contains statistics on the health programs and lays the groundwork for policy recommendations in future reports. Medicaid and the Children's Health Insurance Program cover 76 million low-income and disabled people at a total annual cost of $417 billion to state and federal governments.

"For years, Congress has made Medicaid policy without the kind of detailed information available to inform policy decisions that we received on the Medicare program" through the Medicare Payment Advisory Commission, said Sen. Charles Grassley (R, Iowa). "Congress and other policymakers need to pay attention to this kind of independent data and assessment in order to make Medicaid policies that don't result in busting state budgets with expansions that are implausible and leave people without access to promised benefits."

Among the data in the first MACPAC report:

  • Medicaid covered 68 million people in 2010, and about half were children younger than 19.
  • Two groups account for a disproportionate share of Medicaid spending: individuals 65 and older and people with disabilities.
  • More than 70% of Medicaid enrollees can be defined as being in managed care plans.
  • Medicaid and CHIP spending represented 1.4% of federal outlays in 1970. It increased to 8.1% of outlays in 2010. By comparison, Medicare increased from 3% to 12.3% of federal outlays during the same period.

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