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1 in 4 Uninsured Americans with Chronic Conditions Can't Get Needed Care
National Study Shows Cost Puts Care Out of Reach for Many - Especially Low Income People
Feb. 20, 2002
FURTHER INFORMATION, CONTACT:
ASHINGTON, D.C.—At least 7.4 million working-age Americans with chronic conditions—including diabetes, heart disease and depression—lacked health insurance in 1999, and one in four reported they couldnt get needed medical care at least once in the previous year, according to a new national study released today by the Center for Studying Health System Change (HSC).
Cost was the most-cited barrier to needed care for the uninsured with chronic conditions, and almost two-thirds—or about 4.7 million people—had incomes below 200 percent of poverty, or about $35,000 a year for a family of four in 2001, the study found.
"Almost 5 million Americans face the triple threat of low income, ongoing health problems and no health insurance. Yet, proposed coverage expansions at the federal level dont specifically consider the needs of this high-risk group," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded solely by The Robert Wood Johnson Foundation.
The studys findings are detailed in two new HSC Issue Briefs—Triple Jeopardy: Low Income, Chronically Ill and Uninsured in America and Options for Expanding Health Insurance for People with Chronic Conditions—available by clicking here.
Often perceived primarily as a problem of the elderly, chronic conditions are widespread among working-age Americans, with an estimated 60 million 18- to 64-year-olds having at least one chronic condition, according to HSCs 1998-99 Community Tracking Study Household Survey, a nationally representative survey involving approximately 60,000 people in 33,000 families.
In 1999, 71 percent of working-age adults with chronic conditions were privately insured; Medicare and/or Medicaid covered 14 percent; 12 percent were uninsured and the remainder had other coverage such as military insurance. Unlike the elderly, working-age people with chronic conditions do not qualify for Medicare unless they have severe disabilities.
Uninsured working-age people with chronic conditions report being in worse health and having more functional limitations and are three times more likely not to get needed medical care than people with chronic conditions who are privately insured. Key study findings include:
Without good access to ongoing care, people with chronic conditions are at higher risk for serious disability. A person with diabetes who doesnt receive regular eye and foot exams, for example, has a much higher risk of blindness or amputation.
"Despite their greater needs, it is clear that the uninsured with chronic conditions generally receive significantly less medical care than insured people," said Marie C. Reed, M.H.S., an HSC health research analyst and study co-author.
Federal and state policy makers are debating different proposals to expand health insurance coverage, including refundable tax credits to help people buy coverage in the individual market or expansion of public insurance programs. However, none of these proposals focuses specifically on extending coverage to the uninsured with chronic conditions.
People with chronic conditions typically need more care than healthy people, and this element of known higher expense—above the standard insurance risk—causes conventional concepts of insurance and risk to break down when applied to people with chronic conditions.
"The studys findings suggest that if coverage expansion proposals dont factor in people with chronic conditions greater need for care, the proposals are likely to fall short of reaching this vulnerable group," said Ha T. Tu, M.P.A., an HSC health researcher and study co-author.
Most coverage expansion proposals under discussion would reach a limited number of the uninsured with chronic conditions. For example:
Mary Grealy, president, Healthcare Leadership Council, www.hlc.org
Gail Shearer, director of health policy analysis, Consumers Union, www.consumersunion.org
Don Young, M.D., president, Health Insurance Association of America, www.hiaa.org