Being insured is no guarantee unemployed will seek care

Research suggests they may be unable to cover co-pays and deductibles, or fear they cannot afford the expenses that result.

By — Posted Feb. 7, 2012

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Unemployed people who have private health insurance are less likely to put off care because of cost than those without insurance or on public plans. But they are much more likely than the employed to stay away from the doctor's office.

"Even if you have insurance, you typically have to pay 20% or more of the price, and when you become unemployed, you become more cautious about spending money," said Randall Ellis, PhD, professor of economics at Boston University and president of the American Society of Health Economists. "You put off preventive visits, and if you have the flu, you choose not to go in for treatment."

About 29.3% of the unemployed had private insurance, according to a data brief issued Jan. 24 by the Centers for Disease Control and Prevention's National Center for Health Statistics analyzing adults 18-64 who participated in the National Health Interview Survey for 2009-2010 (link).

This was usually through COBRA, a family member's policy or individual coverage. Of this group, 14.7% said they delayed or did not receive needed medical care because of cost. Only 8.7% of the employed who had insurance said the same thing. About 75.2% of the employed have private insurance.

The NHIS collects data on a nationally representative sample of 75,000 to 100,000 people and has been running since 1957.

The survey found that 51.0% of the unemployed were uninsured and, of this group, 41.2% delayed or went without care because of cost. About 18.2% of the employed did not have health insurance, and 35.2% of this population said they did not seek care because of financial reasons.

About 6.6% of the employed were on a public insurance program, with 11.2% having cost-related access problems. About 19.7% of the unemployed had public insurance, with 16.0% delaying or going without care because of money.

The unemployed were more likely to be in poor health and distressed psychologically, although the report said it's unclear whether unemployment is the cause or the result. The CDC found that 11.3% of unemployed adults were in fair or poor health, but this was true of only 5.3% of the employed. In addition, 6.3% of unemployed adults reported serious psychological distress, but only 1.7% of employed adults reported the same.

The National Bureau of Economic Research declared a recession from December 2007 to June 2009, and large numbers of people were thrown out of work.

The Bureau of Labor Statistics reported an unemployment rate of 5% in December 2007, but the number grew to 9.5% by June 2009. Since the end of the recession, the rate has inched downward but still hovered at 8.5% in December 2011.

Physicians say that when patients show up, particularly those in financial trouble, they try to squeeze more into a visit. Data indicate that they are not showing up as often, if at all. Kaiser Family Foundation research issued Nov. 15, 2011, documented that that the economic malaise trickled down to physician offices. Outpatient office visits declined 17% among patients with private insurance -- from 156 million in the second quarter of 2009 to 129 million in the second quarter of 2011.

Researchers suggest that unemployed people with health insurance may not be able to pay co-pays or deductibles, or they are afraid they will not be able to cover the bills that result.

The insured unemployed may be struggling to pay for premiums, leaving less money for deductibles and co-payments. Premiums for employer-sponsored family plans increased 50% from 2003 to 2010, according to a report issued Nov. 17, 2011, by the Commonwealth Fund. The employee's share went up 63%. People who are unemployed and on COBRA frequently pay the full cost of coverage.

"The premiums are high," said Sara Collins, PhD, vice president for affordable health insurance at the Commonwealth Fund.

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Many delay care, even with coverage

View in PDF

Click to see data in PDF.

When patients lose their jobs, they frequently forfeit health insurance as well. Not all do, but even those who maintain coverage can have a difficult time affording medical care. Figures are from 2009-10 for adults age 18-64.

Coverage type
All adults Private Public Uninsured
Employed 75.2% 6.6% 18.2%
Unemployed 29.3% 19.7% 51.0%
Delayed or did not receive needed medical care due to cost
Employed 8.7% 11.2% 35.2%
Unemployed 14.7% 16.0% 41.2%

Source: Health and Access to Care Among Employed and Unemployed Adults: United States, 2009-2010, Centers for Disease Control and Prevention's National Center for Health Statistics, Jan. 24 (link)

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