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Health Care: See Why Being Insured Matters

Photo: A doctor writing a perscription.Recent figures show that more than 1 in 4 adults 18–64 years old—about 50 million people—had no health insurance for at least part of the past year. Over the past several years, the number of adults 18—64 years old without health insurance for at least part of the year has increased by an average of 1.1 million people each year, and middle-income people account for half of that increase.

Although poverty and lack of insurance are linked, about 1 in 3, or 32%, of middle-income adults aged 18—64 years went without health insurance during some part of 2009. People in all income brackets have been affected, including about 10 million adults in middle-income households and 12 million adults living in poverty according to data from the 2009 National Health Interview Survey.

As a result, millions of Americans have limited access to needed clinical care, including prevention services, because they lack health insurance and are not seeking medical care because of financial concerns.1,2 Missing or delaying health care can lead to poorer health and potentially to greater long-term medical expenditures.3,4

Photo: A mother and child.Not having insurance has a greater impact among those adults who need health care the most. Delays in receiving health care can lead to poorer health and higher medical costs over time, especially for those individuals who already have health issues, including the approximately 40% of the U.S. population with one or more chronic diseases.5 About 60% of adults ages 18-64 with a disability who had recent gaps in the past 12 months in their insurance skipped or delayed care as well.

These problems should be greatly reduced by the Affordable Care Act. The Affordable Care Act is expected to extend insurance coverage to another 32 million people—94% of the nonelderly U.S. population—by 2019.

Prevention is really important and being insured improves access to clinical preventive services. For example, increasing the number of persons who receive five high-value prevention services (i.e., smoking cessation assistance, colorectal cancer screening, breast cancer screening, annual influenza immunization, and daily aspirin to prevent heart disease) could save an estimated 100,000 lives each year.6 By expanding insurance coverage and eliminating cost-sharing for these and other recommended prevention services, the Affordable Care Act will help to increase the number of persons who receive this care.

Ensuring that people follow their prescribed care regimens and promoting healthy behaviors in workplaces, in communities, and in doctor's offices can also help improve health, reduce long-term health care costs, and prevent premature death.

References

  1. Photo: A doctor with a patient.Freeman JD, Kadiyala S, Bell JF, Martin DP. The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies. Med Care 2008;46: 1023–32.
  2. Gruber J. Covering the uninsured in the United States. Journal of Economic Literature 2008;46:571–606.
  3. McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Use of health services by previously uninsured Medicare beneficiaries. N Engl J Med 2007;357:143–53.
  4. Partnership for Solutions. Chronic care: making the case for ongoing care: February 2010 update. Baltimore, MD: Partnership for Solutions; 2010. Available at http://www.rwjf.org/pr/product.jsp?id=50968.
  5. Hoffman C, Schwartz K. Eroding access among nonelderly U.S. adults with chronic conditions: ten years of change. Health Aff (Millwood) 2008;27:w340–8.
  6. National Commission on Prevention Priorities. Preventive care: a national profile on use, disparities, and health benefits. Washington, DC: Partnership for Prevention; August 2007. Available at http://www.rwjf.org/files/publications/other/PreventiveCareReportFinal080707.pdf [PDF - 1.01 MB].

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