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Reducing Uninsurance and Underinsurance in America

According to the Commonwealth Fund, the Affordable Care Act (ACA) helped lower the rate of uninsurance among Americans: from 2010 to 2018, the proportion of uninsured Americans fell from 20% to 12%. However, rates of underinsurance — the issue of having inadequate and often unaffordable health insurance coverage — rose from 23% in 2014 to 29% in 2018. 


Many Americans have gained health coverage in recent years, yet many have costly healthcare. Although underinsured Americans may technically have insurance, high deductibles and copayments ensure that much of their healthcare spending is out-of-pocket. In other cases, relatively expensive monthly premiums take up a large proportion of one’s monthly wages. Combined with additional needs such as rent and transportation, the underinsured American may struggle to save for the future or pay for emergencies. This is especially relevant because underinsured Americans may be at risk for more complicated health problems in the long term.


Many underinsured people delay or refuse medical care due to its overwhelming cost. Compared to 23% of adequately insured Americans, 41% of underinsured individuals say they have delayed necessary medical care to save money. This delay in care is often associated with the lack of transparency in medical billing in America. Because medical treatment costs are not evident to the patient beforehand, patients’ bills may be higher than expected, and their deductible or required copayments are likely very high. In fact, 47% of underinsured adults report problems with medical debt, as opposed to just 25% of adequately insured adults.


No matter the reason, underinsured patients’ tendency to avoid medical screenings and treatments often leads to worse outcomes. Acute conditions like pneumonia can cause more damage to one’s body because patients fail to seek care for initial signs and symptoms. Chronic health conditions such as diabetes and cancer are detected later in life. They are more expensive to treat because patients must undergo more invasive procedures and take more medical leave. Many of these conditions could be diagnosed and treated earlier if patients adhered to a routine schedule of medical appointments. For example, blood sugar screenings and colonoscopies can detect early-stage diabetes and colon cancer.


Underinsured Americans often avoid seeking healthcare to save money in the short term. Nevertheless, failing to see a doctor for routine or immediate care leads to delays in disease detection. Once finally diagnosed, such conditions are more expensive to treat and more likely to cause disability or premature death. No one wants to avoid routine medical appointments or delay care for a problem that worsens their quality of life. It is necessary to make healthcare more affordable in America for many reasons. Giving people access to affordable health insurance would allow them to seek routine and immediate healthcare, thus diagnosing health problems earlier and preventing more long-term complications.


Acknowledgment: The opinions expressed in this article are those of the individual author whose information can be found below.


Diane Bao is a master’s of Public Health student specializing in Epidemiology at the UT Health School of Public Health in Austin. She is originally from Dallas, Texas, and plans to work in epidemiology after receiving her degree. In her spare time, she enjoys creative writing and learning Chinese.


Sources:

“Underinsured Rate Rose from 2014-2018, with Greatest Growth Among People in Employer Health Plans.” The Commonwealth Fund, 7 Feb. 2019, www.commonwealthfund.org/press-release/2019/underinsured-rate-rose-2014-2018-greatest-growth-among-people-employer-health. Accessed 1 June 2022.

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