Working-age American adults experienced a gap in health insurance coverage at a rate of 26 percent during 2011, often because they lost or changed jobs, according to a recent report by The Commonwealth Fund that also shows how difficult it is for people to regain health insurance on their own after losing employer-sponsored coverage.
Those who went without coverage for a year or longer was at 69 percent, while 57 percent were uninsured for two years or more, according to the report, based on the 2011 Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults.
Among those who were uninsured at the time of the survey or who had experienced an insurance gap, 41 percent said they had previously had employer-sponsored coverage. Two-thirds (67 percent) of those who lost their employer-sponsored coverage cited a loss or change of a job as the primary reason for losing coverage.
Buying coverage on their own proved to be very difficult or not an option for many adults, according to the report, for 62 percent of those who tried to buy individual health insurance policies in the past three years found it very difficult or impossible to find affordable coverage.
Nearly one-third (31 percent) were turned down, charged a higher price, or had a condition excluded because of a pre-existing condition. Sixty percent of those who tried to purchase a plan on their own said they found it very or somewhat difficult to compare the benefits provided by different plans. Nearly half (45 percent) said they never bought a plan, mainly because of cost.
“For people who lose employer-sponsored coverage, the individual market is often the only alternative, but it is a confusing and largely unaffordable option,” Commonwealth Fund Vice President Sara Collins, lead author of the report said in a statement. “As a result, people are going a year, two years, or more without health care coverage, and as a result going without needed care.”
While 92 percent of working-age adults with continuous health insurance reported having a regular doctor, that rate fell to 76 percent among those who had a coverage gap of up to one year and 46 percent among those who had a gap of a year or more. Rates of preventive cancer screening were also lower for those with coverage gaps and continued to drop as people spent longer periods without insurance.
Seventy percent of continuously insured respondents had had their cholesterol checked in the past five years, compared to half of those who had a coverage gap of less than a year and 33 percent of those who had a gap of a year or more. Three-quarters (74 percent) of insured women ages 40 to 64 had received a mammogram in the past two years, compared to only 28 percent of women in that age group with a coverage gap of a year or more. More than four of five (83 percent) of adults with continuous coverage had had their blood pressure checked in the past year, compared to 70 percent of those with a coverage gap of less than a year, and 51 percent of those without coverage for a year or longer.
The report, by Commonwealth Fund researchers Sara Collins, Ruth Robertson, Tracy Garber, and Michelle Doty, is the second in a series called Tracking Trends in Health System Performance that The Commonwealth Fund will release over the next several years.
Some young adults are turning to their parent’s health insurance plans, as allowed under the Affordable Care Act, which permits adult children up to age 26 to join or stay on a parent’s health insurance. Nearly half (46 percent) of young adults ages 19 to 25 said they had stayed on or joined a parent’s insurance policy in the last 12 months, and 23 percent of parents with children under age 26 reported that they had an adult child stay on or enroll in their health plan.
Young adults in higher-income households were much more likely to have been helped by the new option than those in lower-income households. This is likely because adults in higher-income households are more likely to have health insurance with dependent coverage. Awareness of this new provision was high among working-age adults, with 63 percent saying they were aware of the provision.
Half of adults were aware of the ACA’s new Pre-Existing Condition Insurance Plans that offer coverage to people who were previously unable to obtain coverage because of a health condition and who have been uninsured for at least six months
The major provisions of the health reform law, to be implemented starting in 2014, will have the biggest effect in bridging health care coverage gaps, the authors say, through an expansion in eligibility for Medicaid, subsidized private insurance available through new state health insurance exchanges, and new rules that will prevent insurers from denying coverage or charging people more based on pre-existing conditions or gender.
The law will also make it easier for consumers who must buy health insurance on their own to purchase a health plan that meets their needs through clearly defined benefit packages and tools to help consumers choose among plans. The new insurance exchanges, for example, will be required to offer a cost-calculator that will inform families about their health plan costs after adjusting for any premium or cost-sharing subsidies.
