Over-Insured: Health Insurance's Dark Side

In the United States, the issue of health insurance is a pressing matter, with a significant number of individuals lacking adequate coverage. As of 2022, around 304 million people in the country had some form of health insurance, marking a notable increase from 257 million in 2010. However, this still leaves over 25 million people uninsured. The Affordable Care Act (ACA) played a crucial role in reducing the number of uninsured, but the repeal of the individual mandate has led to a rise in those without coverage.

The lack of universal health insurance results in varying levels of coverage through different private and public insurance programs. In 2021, employer-provided insurance covered nearly half of the insured population, while Medicaid and Medicare insured 18.9% and 15.4% respectively. The absence of insurance has concrete consequences on people's health and finances. Uninsured individuals are less likely to receive preventive care and often face unaffordable medical bills, leading to medical debt.

Furthermore, the issue of underinsurance also persists, with high out-of-pocket costs and deductibles relative to income leaving people vulnerable. This is particularly true for those with employer-based coverage, where the proliferation and size of deductibles have been steadily increasing. As a result, many Americans are burdened with high healthcare costs and medical debt, impacting their financial stability.

The COVID-19 pandemic has further exacerbated these issues, causing economic disruption and leaving more people uninsured or underinsured. With potential changes in employment and income, many households are facing challenges in affording healthcare costs, which can quickly turn into medical debt.

The uninsured are less likely to receive preventive and screening services

The type of health insurance and the continuity of coverage have also been found to affect the receipt of appropriate preventive and screening services. Insurance coverage for preventive care increases men's receipt of preventive services more than it does that of women. Men with no coverage for preventive services were much less likely than men with complete coverage to receive them. Women with no preventive services coverage also received fewer of these services than did women with full coverage.

The uninsured are also less likely to receive recommended screening services and are less likely to receive them at the frequencies recommended by the United States Preventive Services Task Force than are insured adults.

The uninsured are more likely to face unaffordable medical bills

Unaffordable Medical Bills for the Uninsured

According to a 2022 survey, more than 1 in 4 adults (28%) reported delaying or not seeking healthcare due to cost. This included dental care, prescription drugs, mental health care, or medical care. A similar share of adults (29%) reported foregoing medical care, prescription drugs, or mental health care due to cost.

Hispanic adults, adults in worse health, and uninsured adults are more likely than others to delay or forego healthcare due to cost. In 2022, 57% of uninsured adults reported delaying or not getting care due to cost, compared to 25% of insured adults.

Medical Debt

Medical debt is a persistent problem in the United States, even among those with health insurance. A 2022 survey found that 41% of adults reported having some amount of healthcare debt. Of those with medical debt, nearly two-thirds (64%) put off or postponed getting necessary care, and half (51%) did not receive a recommended medical test or treatment.

Income and Medical Debt

People with lower incomes are more likely to delay or go without medical care due to cost. Adults with incomes below 200% of the federal poverty level are more likely to delay or go without medical care than those with incomes above 200% of the federal poverty level (13% vs. 6%).

Additionally, among people with employer-sponsored insurance, those with lower incomes spend a larger share of their income on insurance premiums and cost-sharing.

Insurance Status and Medical Debt

While most adults (90%) have health insurance, adults who were uninsured for part of the year are more likely to report having medical debt (14%) than those who were insured for the full year (8%) or uninsured for the whole year (11%).

Demographics and Medical Debt

People in worse health and those living with a disability are more likely to report medical debt. Adults living with a disability are more likely than those without to report owing medical debt (13% vs. 6%). Similarly, adults who report their health status as "fair" or "poor" are more likely to say they owe medical debt than those who report being in "good" health.

Middle-aged adults and Black people are also more likely to have medical debt. Black Americans are far more likely than people of other racial and ethnic groups to report having medical debt (13% vs. 8% for White and 3% for Asian Americans).

The uninsured are less likely to have a regular source of care

Uninsured people are less likely to have a regular source of health care. This is because the cost of health insurance is often too high, and many people do not have access to coverage through their jobs. In addition, undocumented immigrants are ineligible for federally funded coverage. As a result, uninsured people are more likely to delay or forgo health care due to costs. They are also less likely to receive preventive care and services for major health conditions and chronic diseases. This can lead to preventable conditions or chronic diseases going undetected, resulting in negative health consequences and higher mortality rates.

Uninsured people are less likely to have a regular source of health care because they often cannot afford the high cost of insurance. In 2022, 64% of uninsured nonelderly adults cited the cost of coverage as the main reason for lacking insurance. Many uninsured people do not have access to coverage through their jobs, and some may be ineligible for financial assistance. Undocumented immigrants, in particular, are ineligible for federally funded coverage. As a result, uninsured people often face unaffordable medical bills and medical debt when they do seek care.

The lack of a regular source of health care leads to delayed or forgone health care for uninsured people. They are more likely to postpone or skip health care due to costs. In 2022, 20% of uninsured adults reported going without needed care because of cost, compared to only 3% of adults with private coverage and 8% with public coverage. Uninsured people are also less likely to receive preventive services and recommended screening tests. This is partly because half of the uninsured do not have a regular place to go when they are sick or need medical advice, while most insured people do.

The consequences of not having a regular source of care can be severe for uninsured people. They are more likely to have preventable conditions or chronic diseases go undetected, leading to negative health outcomes. Uninsured people are at an increased risk of being diagnosed with cancer and other diseases at later stages, resulting in higher mortality rates. They also receive fewer diagnostic and therapeutic services when hospitalized and have higher mortality rates in the hospital.

The uninsured are more likely to delay or forgo care due to costs

People without health insurance are more likely to delay or forgo care due to costs. In 2022, 28% of US adults reported delaying or going without medical care, prescription drugs, mental health care, or dental care due to cost. This figure rose to 43% when accounting for people who reported that they or a family member had put off or postponed needed healthcare due to cost.

Uninsured adults are far more likely than those with insurance to postpone healthcare or forgo it altogether. This can have severe consequences, particularly when preventable conditions or chronic diseases go undetected. Uninsured people are less likely to receive preventive care and services for major health conditions and chronic diseases. They are also less likely to receive necessary follow-up screenings, leading to an increased risk of being diagnosed at later stages of diseases, including cancer, and higher mortality rates than those with insurance.

In addition, when uninsured people are hospitalized, they receive fewer diagnostic and therapeutic services and have higher mortality rates than those with insurance. They are also more likely to face unaffordable medical bills when they do seek care, which can quickly lead to medical debt.

The decision to delay or forgo care due to cost is not limited to the uninsured. Even among insured adults, many continue to face barriers to accessing medical care.

The uninsured are less likely to receive timely treatment

The United States is the only major industrialized nation without universal health insurance. The number of uninsured people has increased from 40 million in 2000 to nearly 47 million in 2005. This section will discuss how the uninsured are less likely to receive timely treatment and the factors contributing to this issue.

Uninsured Individuals are Less Likely to Receive Preventive and Screening Services

Uninsured adults are less likely than adults with any kind of health coverage to receive preventive and screening services and less likely to receive these services on a timely basis. Health insurance that provides more extensive coverage of preventive and screening services is likely to result in greater and more appropriate use of these services.

Uninsured Cancer Patients Generally Have Poorer Outcomes

Uninsured cancer patients generally have poorer outcomes and are more likely to die prematurely than persons with insurance, largely because of delayed diagnosis. This finding is supported by population-based studies of breast, cervical, colorectal, and prostate cancer and melanoma.

Uninsured People with Chronic Diseases are Less Likely to Receive Appropriate Care

Uninsured people with chronic diseases are less likely to receive appropriate care to manage their health conditions than are those who have health insurance. For the five disease conditions examined (diabetes, cardiovascular disease, end-stage renal disease, HIV infection, and mental illness), uninsured patients have worse clinical outcomes than insured patients.

Uninsured Hospitalized Patients Experience Higher Rates of Death and Receive Fewer Services

Uninsured patients who are hospitalized for a range of conditions experience higher rates of death in the hospital, receive fewer services, and are more likely to experience an adverse medical event due to negligence than are insured patients.

Uninsured Adults with Traumatic Injuries are Less Likely to be Admitted to Hospital and More Likely to Die

Uninsured persons with traumatic injuries are less likely to be admitted to the hospital, receive fewer services when admitted, and are more likely to die than insured trauma victims.

Uninsured Patients with Acute Cardiovascular Disease are Less Likely to be Admitted to Hospital and More Likely to Die

Uninsured patients with acute cardiovascular disease are less likely to be admitted to a hospital that performs angiography or revascularization procedures, are less likely to receive these diagnostic and treatment procedures, and are more likely to die in the short term.

In conclusion, the uninsured are less likely to receive timely treatment due to a variety of factors, including lack of access to preventive and screening services, poorer outcomes for cancer patients, inadequate care for chronic diseases, higher rates of death and fewer services for hospitalized patients, lower admission rates and higher mortality for traumatic injury patients, and lower admission rates and higher mortality for patients with acute cardiovascular disease.

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