Health Insurance Coverage Survey Finds Widespread Coverage Gaps, Financial Stress

Many of the more than 4,000 people surveyed by the Commonwealth Fund said their care costs are a significant and in some cases insurmountable burden.  

Nearly half (43%) of working-age adults had spotty health insurance coverage in the first half of 2020, and many more faced dauntingly high deductibles and out-of-pocket costs, and hard choices on paying the rent, buying food, or seeking healthcare, according to a new survey released today by the Commonwealth Fund.

“The survey shows a persistent vulnerability among U.S. working-age adults in their ability to afford coverage and healthcare,” said study lead author Sara R. Collins, Commonwealth Fund Vice President for Healthcare Coverage, Access, and Tracking.

“That vulnerability could worsen if the COVID-19 pandemic and related economic downturn continue,” Collins said. “Coverage inadequacy is compromising people’s ability to get the care they need and leaving many with medical debt at a moment of widespread health and financial insecurity, and an uncertain future.”

The Biennial Health Insurance Survey, which the Commonwealth Fund has conducted since 2001, randomly interviewed 4,272 adults via cellular and landline telephone in Spanish and English from January through June.

Among the findings:

• People of color, small business workers, people with low incomes, and young adults had the highest uninsured rates. More than one-third of Latino adults, small business workers, and adults with low incomes were either uninsured or spent some time uninsured in the past year.
   
• The growth in the underinsured since 2010 has been driven by employer health plans with inadequate coverage. One-quarter of adults with employer plans were underinsured.
   
• One-quarter of working-age adults with adequate coverage for the full year reported medical bill problems or debt in the past year.
   
• Half of adults who spent any time uninsured or underinsured reported problems paying medical bills or that they were paying off medical debt over time.
   
• African Americans were significantly more likely than whites to report problems with medical bills (45% vs. 35%).
   
• Among adults who reported any medical bill or debt problem 37% said they had used up all their savings to pay their bills, 40% had received a lower credit rating as a result of their medical debt, and 26% were unable to pay for basic necessities such as food, heat, or their rent.

The survey also noted that Americans are shouldering a heavying increase in premiums, out-of-pocket costs and copays over the past decade that is leaving them financially stressed and vulnerable to lapses in coverage.

In 2010, for example, 7% of people in either employer or individual private plans had deductibles that amounted to 5% or more of income, an indicator of underinsurance. By 2016, the share had more than doubled to 15%.

In addition, between 2010 and 2020, the share of privately insured adults with deductibles of $1,000 or more doubled — from 22% to 46%, the survey found.

“Even before the pandemic, people were struggling with inadequate health coverage and mounting medical debt,” said Commonwealth Fund President David Blumenthal, MD. “It has never been more important to ensure that all U.S. residents have affordable, comprehensive coverage to survive this pandemic and beyond.”

To alleviate the problem, the Commonwealth Fund is calling for expanding Medicaid in the 12 states that have yet to do so, enhancing Affordable Care Act marketplace subsidies, increasing outreach and enrollment efforts, and banning non-ACA compliant short-term policies that expose people to catastrophic healthcare costs.