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Reducing Lack of Insurance and Underinsurance in America

Because the U.S. lacks universal health insurance, unlike other first-world countries, lack of insurance and underinsurance heavily impact Americans, especially historically marginalized communities. As described in the International Journal of Health Services, unisurance is the state of lacking health insurance coverage, and underinsurance is having inadequate health insurance. One may technically be insured, but seeking healthcare can still be prohibitively expensive due to large out-of-pocket payments, monthly premiums or deductibles.

For example, Hispanic, Black and low- and middle-income Americans were less likely to have health insurance than their white or high-income counterparts. Underinsured and uninsured Americans also had a lower health-related quality of life and more medical debt than insured Americans.

Aside from race and class, one’s employment also affects insurance status. Most middle-aged Americans receive health insurance through an employment-based plan. This system encourages Americans to find jobs, especially full-time positions — part-time jobs are less likely to provide health coverage. Nevertheless, an analysis of hours worked between American and European employees found that employment-based insurance is one reason Americans work more hours than Europeans. Compared to Europeans with universal health insurance, Americans who work too few hours per week will qualify as part-time workers and lose health coverage. This is especially detrimental to Americans with multiple part-time jobs; they’re sometimes overworked but cannot qualify for employment-based insurance at any particular job, increasing their risk of both uninsurance and health problems associated with overworking.

Health insurance has been a critical issue in the last few presidential elections. Democrats tend to support expanding and funding public health insurance programs like Medicare. Republicans favor a free-market approach and reduced funding. In any case, uninsurance and underinsurance are public health problems in the U.S. When Americans cannot afford healthcare, they often delay treatment, possibly leading to worse medical debt and quality of life in the long term.


Feng, Zhigang, and Kai Zhao. “Employment-based Health Insurance and Aggregate Labor

Supply.” Journal of Economic Behavior & Organization, vol. 154, no. 1, 2018, pp. 156-174. doi:10.1016/j.jebo.2018.08.009. Accessed 27 May 2022.

Link, Carol L., and John B. McKinlay. “Only Half the Problem is Being Addressed:

Underinsurance is as Big a Problem as Uninsurance.” International Journal of Health Services, vol. 40, no. 3, 2010, pp. 507-523. doi:10.2190/HS.40.3.g. Accessed 22 May 2022.


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