“We’re moving in a direction where you can be insured all year and still face medical bankruptcy,” said Cathy Schoen, the study’s lead author and a senior vice president for research and evaluation at the Commonwealth Fund, a private foundation in New York specializing in health research.
According to the study, continued rising medical care costs along with a growing number of insurance plans that require patients to pay a higher portion of their medical bills has led to a 60 percent increase in the number of underinsured adults from 2003 to 2007. The Commonwealth Fund first calculated the number of underinsured in 2003 when it estimated that 16 million Americans did not have sufficient coverage.
As the nation debates how best to improve its health care system, including how to insure the increasing number of Americans without coverage, policy makers also need to discuss the quality of available coverage, said Karen Davis, the president of the Commonwealth Fund.
“Lack of insurance is only part of the problem, as even the insured have serious gaps in coverage,” she said.
The study, to be published by the medical policy journal Health Affairs, also indicates that the sharpest increase in the underinsured were middle-class families whose coverage still left them vulnerable to medical costs equal to 10 percent more of their incomes. While coverage offered by large companies remains fairly generous, people who try to buy individual policies or who are covered through small companies increasingly must settle for policies that require high deductibles or that sharply limit the benefits as way of reducing the size of the premiums.
As with the approximately 50 million uninsured Americans, the underinsured often choose to forgo necessary medical care, the study indicated. Twice as many people who are underinsured said they did not fill a drug prescription or see a recommended specialist for care, the survey found, compared with the number of people who had more generous coverage. They also tend not to get preventive care, choosing not to get mammograms or have their cholesterol checked.