The Problem of Underinsurance and How Rising Deductibles Will Make It Worse: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014

Abstract

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year-or 31 million people-had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured.These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey.The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014.Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost.Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more. BACKGROUNDThe Affordable Care Act has transformed the health insurance options available to Americans who lack health benefits through a job.Numerous surveys have indicated that the law's coverage expansions and protections have reduced the number of uninsured adults by as many as 17 million people. 1 But Congress intended the Affordable Care Act to do more than expand access to insurance; it intended for the new coverage to allow people to get needed health care at an affordable cost.Accordingly, for marketplace plans, the law includes requirements like an essential health benefit package, cost-sharing subsidies for lowerincome families, and out-of-pocket cost limits.2 For people covered by Medicaid, there is little or no cost-sharing in most states.But most Americans-more than 150 million people-get their health insurance through employers.3 Prior to the Affordable Care Act, employer coverage was generally far more comprehensive than individual market coverage.4 However, premium cost pressures over the past decade have led companies to share increasing amounts of their health costs with workers, particularly in the form of higher deductibles.5 In this issue brief, we use a measure of "underinsurance" from the Commonwealth Fund's Biennial Health Insurance Survey to examine trends fromTo learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.Commonwealth Fund pub. 1817 Vol. 13The mission of The Commonwealth Fund is to promote a high performance health care system.The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy.

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