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CDC Vital Signs: Health Insurance Coverage and Health Care Utilization — United States, 2006–2009 and January–March 2010

Tuesday, November 9, 2010 – 12:00pm ET

Operator: Good morning, everyone. Thank you all for standing by. Welcome to today's conference call. At this time your lines have been placed on listen only for today's conference. During the question and answer portion of the call you will be limited to one question and one follow up. Please be sure to record your name and affiliation so you may be introduced to ask your question. Once again, that is one question and one follow up question for our Q & A portion. The conference is being recorded today. If you have objects you may disconnect at this time. I will now turn the conference over to Mr. Tom Skinner, senior public affairs officer for the CDC. Mr. Skinner, you may proceed.

Tom Skinner: Thanks, Jill. Thank you all for joining us today for this telebriefing on the release of CDC's Vital Signs report on health insurance coverage and health care utilization. This is the fifth Vital Signs report that CDC has release asked Dr. Frieden will be saying more about Vital Signs prior to giving introductory remarks on today's report. We'll then open up the phone lines to answer your questions. Joining us for the Q & A are Dr. Chesley Richards, prevention through health care and Dr. Robert Cohen, a statistician with CDC's National Center for Health Statistics. So let me turn the call now over to the director of the centers for disease control and prevention, Dr. Thomas Frieden.

Tom Frieden: Hello. Good afternoon and thank you very much for joining us. Vital Signs began several months ago as an early Tuesday in the month release of key health information. Our first was in July of 2010 and covered colon and breast cancer screening. Our schedule for releases was established about a year ago when we first conceptualized the data release process.

Today's data is based on information from the National Health Interview Survey or NHIS. This has been conducted continuously for more than 50 years. It is a primary source of information on health. It's conducted by trained interviewers. It's an in-person household survey interviewing nearly 90,000 individuals from around 35,000 households. One of the very positive things about this is that it provides early release information and it's been doing this for ten years since April of 2001. This gives estimates of the most current information on health of the United States population six months after collection of new data. It's provided quarterly with periodically more in-depth information.

Today's report is on health insurance coverage and health care utilization and the bottom line is that uninsurance of young and middle-class adults increased by 4 million people from 2008 to the first quarter of 2010. Half of those who are uninsured are non-poor and there's a serious impact on access to needed health care. Specifically, among adults age 18 to 64, the proportion who had no insurance for at least part of the prior year increased from 46 million to 49.9 to be exact, 4 million more from 2008 to the first quarter of 2010. A second way to look at it is chronic uninsurance. People who have been without health insurance coverage for more than 12 months and that number also increased substantially from 27.5 million in 2008 to 30.4 million in the first quarter of 2010. That's an increase of 3 million in chronically uninsured adults. Now the population of particular concern is from 18 to 64 years of age. The population is 65 and over has had high and stable coverage through Medicare which has maintained near universal coverage for those 65 and older. For those under 65, private insurance coverage has been falling steadily for at least the past ten years.

The public insurance safety net has more than protected children, but while public coverage provided some safety net for adults it wasn't enough to offset the loss of private coverage. Both adults and kids lost private coverage over the past decade. Specifically, private insurance of adults fell by 9% and although public insurance increased by about 5% as a net, this led to an increase of uninsurance from the 18 to 64-year-olds to 22% of 18 to 64-year-olds. The trends are very different among children where even though the proportional decrease in private insurance was even greater. There was a much larger increase in public insurance through Medicaid and chip resulting in an overall decrease from 12% of kids being underinsured to 7% of kids being underinsured. While they get started not so far away ten years ago, 18% of adults being uninsured and 12% of kids being uninsured. What happened is its 22% versus 7%. Fundamentally, as private insurance coverage fell, the safety net protected children, but did not adequately protect adults.

Now, the data also allow us to debunk two myths about health care coverage. The first myth is that it's only the poor who are uninsured. In fact, half of the uninsured are over the poverty level and one in three adults under 65 in the middle income range defined arbitrarily here between 44,000 and $65,000 a year for a family of four were uninsured at some point in the year. The second myth is that it's only healthy people who are uninsured and that it's young, healthy people and they make a choice to not have health insurance. In fact, about more than two out of five individuals who are uninsured at some point during the past year had one or more chronic diseases and this is based on just a partial list of chronic diseases. So the actual number may be higher than that. Just to give you an example that includes 15 million people who had one of three conditions. High blood pressure, diabetes or asthma, and uninsured people with asthma were five times more likely not to get needed care with diabetes and hypertension who are six times more likely to not get needed care. Even a short gap in insurance tripled the risk of skipping care because of cost, and more than 40% of adults in this age group without health insurance in the past year skipped care because of cost. Now what that means as a doctor, I can tell you that if you have asthma and you don't get care you end up in the emergency department much more commonly, expensive and disabling exacerbations of asthma. If you have diabetes and you don't get needed care in the short term you end up in the intensive care unit. In the long term you end up with kidney failure on dialysis with blindness from the eye complications of diabetes and with amputations of feet or legs. With high blood pressure, if you fore go care you end up with a stroke, heart attack, with disability or possibly in long-term care.

I'd like to close with two additional points and then make some conclusions and have time for questions. The first is that health insurance is a necessary, but not a sufficient condition for effective prevention and earlier report from the MMWR showed that in a jurisdiction that it increased access to healthcare it was also necessary to address primary care capacity. In addition to improve the quality of care, we need to have information to support prevention and to structure care for prevention and some of the new criteria that are in the affordable care act, for example, eliminating co-payments for preventive services will allow that kind of better focus prevention. A moment on limitations, you may find the numbers a little confusing because there are various ways to measure a lack of health insurance. You can measure it at a point in time, are you uninsured now when I speak to you in an interview situation. You can ask if you're ever uninsured in the past year and you're uninsured continuously for the past year. Other surveys such as those by the census bureau have different estimates, but the trends are all similar and when you look at our point in time estimates, they are very close to those of other surveys. We also in this report don't address patient outcomes, just whether people have insurance and whether they seek care. In summary, was there a 4 million increase in the number of people who didn't have insurance at some point in a year. 3 million more people who are chronically uninsured that is for more than a year. This affects poor and middle income Americans, specifically in the 18 to 64-year-old age group. People who are uninsured are much less likely to have a regular doctor and much more likely to skip or delay care due to cost and this affects those with chronic conditions where more than 40% who do have a chronic condition and don't have insurance don't seek the care they need. Middle-aged adults who don't get preventive care enter Medicare sicker and subsequently require more doctor visits, more hospitalizations and have higher costs. Uninsurance of young and middle class adults has increased by 4 million between 2008 and the first quarter of 2010. Half of the uninsured are non-poor and this decreases access to needed health care. Thank you very much.

Tom Skinner: Okay. Jill, I think we're ready for question and answer, please.

Operator: Thank you, sir. At this time if you would like to ask a question please be sure to press star 1 on your touch-tone phone and please record your name and affiliation to ask your question. Once again, that is star 1 at this time. Please stand by for question. Our first question comes from Mike Stobbe with the Associated Press. Sir, your line is open.

Mike Stobbe: Hi. Thank you for taking the question. I have two questions. First, was there any trend data on the percent of people who said that they were foregoing care? I just see just kind of a snapshot, and i have a second question when that's over.

Tom Frieden: Maybe Robin Cohen from the national center from health statistics, do you want to address that briefly?

Robin Cohen: Yes. The early release report, one of the measures in the early release report is looking at foregone care. You can look at the reports that are on the NCHS website and you would find the information there.

Mike Stobbe: It shows that what it was in the past?

Robin Cohen: It would be—yeah. It would be did not get needed medical care because of cost. It's not broken down by insurance type. It's just overall.

Mike Stobbe: Okay. I'll go back and look. The other question as Dr. Frieden was pointing out. There are different ways to look at the data and one way we looked at it is the number any percent of people who say at the time of the interview that they're uninsured. That doesn't seem to be increasing much, at least by percentage of Americans. I was wondering if we've been through recession maybe Dr. Frieden answered this by addressing the kids, but were you surprised that we haven't seen a larger jump in the uninsured than we've seen?

Tom Frieden: I'm not quite sure what information you're looking at. All of our measures of uninsurance have increased and increased fairly substantially. The uninsured 18 to 64 times the interview has gone from 18% ten years ago up to 22% now, 21.5% now. The other question is how much of that is because people—if people lose their jobs they often lose their health insurance as well, and there are multiple factors contributing to that increase. Jill, our next question?

Operator: Once again, if you would like to ask a question please press star 1 and record your name and affiliation at this time. Mr. Skinner, we have no further questions at this time.

Tom Skinner: Okay. If there are no further questions as—if you do have questions that come up later in the day you can certainly call the CDC press office at 404-639-3286 and we'll try to provide you with subject matter experts to answer your questions. So we'll conclude, Jill, if there are no further questions, is that correct?

Operator: We have no further questions, Mr. Skinner.

Tom Skinner: Okay. All right. Thank you for your time.

Operator: That does conclude today's conference call. We thank you all for participating. You may now disconnect and have a great rest of your day.

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