Middle-income Americans go without health insurance

2006

A growing proportion of middle-income Americans are finding themselves without health insurance coverage and one in five Americans of working age are paying off medical debts, a new report has warned.

Four out of 10 (41 per cent) of working-age Americans with incomes between $20,000 and $40,000 a year were uninsured for at least part of the past year according to the not-for profit Commonwealth Fund - a dramatic increase from 2001 when just over a quarter (28 per cent) of those with moderate incomes were uninsured,

Lower-income adults were still the most likely to be uninsured. The vast majority of the uninsured are in working families: of the estimated 48 million working-age Americans uninsured during the year, two-thirds were in families where at least one person was working full time.

The problem is particularly acute for small business owners and their employees. Almost two-thirds (63 per cent) of working uninsured adults were solo business owners or were working for firms with fewer than 100 employees.

"The jump in uninsured among those with modest incomes is alarming, particularly at a time when our economy has been improving," said Commonwealth Fund president and study co-author Karen Davis.

"If we don't act soon to expand coverage to the uninsured, the health of the U.S. population, the productivity of our workforce, and our economy are at risk."

The study also reveals that a startling number of adults are now grappling with unpaid medical bills. One in five (21 per cent) adults, including insured and uninsured, currently has medical debt they are paying off over time, and a third (34 per cent) either had medical bill problems in the past year or were paying off accrued medical debt.

The survey of adults ages 19 to 64 reveals that medical debt is not an issue for the uninsured alone. Nearly two-thirds (62 per cent) of adults with medical bills or debt problems said that they or their family member were insured when they incurred the debt.

The survey looked at the medical consequences families face when they go without health care coverage. Researchers found that an alarmingly high proportion – almost six out of 10 - adults with a time uninsured in the past year with chronic illnesses, such as diabetes and asthma, went without or skipped their medications because they couldn't afford them.

This same group was also more likely to go to an emergency room or hospital for chronic conditions than those with insurance. One third (35 per cent) of uninsured adults with chronic conditions visited an ER, or stayed in the hospital overnight, or did both, compared to 16 per cent of those insured all year with a chronic condition.

Americans without health insurance were also more likely to go without recommended cancer, cholesterol, and blood pressure screenings.

"These findings paint a disturbing picture of the day-to-day impact of being uninsured on the physical as well as financial health of millions of Americans," said Sara Collins, Commonwealth Fund senior program officer, and the study's lead author.

"The uninsured are more likely to go without preventive care or screening tests that could prevent more serious and costly health problems. For an uninsured person who is unlucky enough to get sick, it is easy to see how quickly they can fall into a downward spiral of debt, forgone care, and poorer health."

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