Underinsured Americans

In addition to those who are uninsured, almost 30% of adults under age 65 who have insurance are underinsured (Commonwealth Fund, 2017b). In other words, they have insurance but still can’t afford to pay all their medical bills. Underin- surance is most common among poorer people and those with chronic health problems (Commonwealth Fund, 2017b).

Underinsurance occurs when individuals can’t afford to pay required insurance premiums, deductibles, or copayments. It can also occur when insurers either cap reimbursements per treatment or don’t cover certain treatments such as drugs or nursing home care. As a result, people often face bankruptcy and often skip needed medical care.

The Consequences of Underinsurance and Lack of Insurance

Uninsured and underinsured persons are considerably less likely than others to report that they are in good health (Sommers, Gawande, and Baicker, 2017). It is not surprising that they are also less likely than insured Americans to receive needed health care, more likely to suffer from a variety of health complaints, and more likely to die from potentially treatable health problems.

This does not mean, however, that uninsured and underinsured persons have no access to health care. Federal, state, and some local governments provide clinics and public hospitals that offer low-cost or free care to such individuals. In addition, governments sometimes provide low-cost or free vaccination, cancer screening, and well-child programs. These facilities and programs, however, are not always geographically accessible to those who need them. In addition, these facilities are continually underfunded, so individuals may have to wait hours for emergency care and weeks or months for nonemergency care.

Uninsured and underinsured persons also sometimes can obtain health care through the private sector. First, some individuals can find private doctors who will reduce or waive their fees, and some live in communities where nonprofit hospitals offer inexpensive outpatient clinics. Second, uninsured persons can obtain care for both acute and chronic, emergency and nonemergency health problems from hospital emergency departments. Although emergency departments legally can refuse care to anyone who is medically stable, many provide at least basic treatment to all who present themselves. Afterward, however, individuals can face stratospheric bills. Finally, uninsured persons sometimes volunteer for experimental trials of new drugs to obtain at least sporadic treatment. Yet in such experiments, some patients receive placebos, some receive drugs that prove ineffective, and some receive drugs that prove harmful. Moreover, even if the drugs work well, patients receive only temporary benefit because the drugs become unavailable after the experiments end.