figure 1. we can’t continue on our current path: growth in the uninsured
DESCRIPTION
Figure 1. We Can’t Continue on Our Current Path: Growth in the Uninsured. Uninsured Projected to Rise to 61 million by 2020. 45.7 Million Uninsured, 2007. Millions uninsured. Uninsured (15%). Employer (55%). Military (1%). Individual (5%). Medicaid (10%). Medicare (13%). - PowerPoint PPT PresentationTRANSCRIPT
THE COMMONWEALTH
FUND
1Figure 1. We Can’t Continue on Our Current Path:
Growth in the Uninsured
Data: Analysis of the U.S. Census Bureau, Current Population Survey Annual Social and Economic Supplement (CPS ASEC), 2001–2008; projections to 2020 based on estimates by The Lewin Group.
Uninsured(15%) Employer
(55%)
Medicaid(10%)
Medicare(13%)
Total population
Military(1%)
Individual(5%)
38 4042 43 43 45
47 46 47 48 49 50 52 53 55 56
6160595857
0
10
20
30
40
50
60
70
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Projected estimates
Uninsured Projected to Rise to 61 million by 2020
Millions uninsured
45.7 Million Uninsured, 2007
THE COMMONWEALTH
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2Figure 2. 75 Million People Were Uninsured for All or Part of the
Year Before the Start of the Recession
Total Population = 299 million
Insured All Year224m75%
UninsuredPart Year
37m12%
UninsuredAll Year
38m13%
Source: Analysis of the 2006 of the Medical Expenditure Panel Survey by B. Mahato of Columbia University for The Commonwealth Fund.
Under-65 Population = 260 million
Insured All Year189m73%
UninsuredPart Year
34m13%
UninsuredAll Year
37m14%
THE COMMONWEALTH
FUND
3Figure 3. Uninsured Rates High Among Adultswith Low and Moderate Incomes, 2001–2007
15 18
35
1724
6 7
910
15
11
16
7 11
1 5
33
16
330
25
50
75 Insured now, time uninsured in past year
Uninsured now
Percent of adults ages 19–64
Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–$34,999, middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005 and 2007, low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more. Subgroups may not sum to totals because of rounding.Source: S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007 (New York: The Commonwealth Fund, August 2008).
4
24
49
28
13
Total Low income
Moderate income
Middle income
High income
28
50
41
18
8
20012007
20012007
20012007
20012007
20012007
THE COMMONWEALTH
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4Figure 4. The Majority of U.S. Workers Get Their
Health Insurance Through Employers, 2007
Own employer coverage
(56%)
Other employer coverage
(16%)
Public programs(5%)
*Includes those with individual insurance and “other” responses.Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
Uninsured(14%)
Other coverage*(9%)
122.2 Million Full- and Part-Time Workers Ages 19–64
THE COMMONWEALTH
FUND
5Figure 5. 2009 Changes in Coverage at Different Levels of
Unemployment (Base of 4.6% in 2007)
Source: J. Holahan and A.B. Garrett, Rising Unemployment, Medicaid, and the Uninsured, Publication No. 7850 (Washington: Kaiser Commission on Medicaid and the Uninsured, January 2009).
-5.9
-8.3
-10.7
-13.2
2.43.4
4.45.4
2.63.7
4.85.8
-15
-10
-5
0
5
10
7% Unemployment 8% Unemployment 9% Unemployment 10% Unemployment
ESI Medicaid/SCHIP Uninsured
Millions of People
THE COMMONWEALTH
FUND
6
999791
80
57
69
9994
90
78
49
63
0
25
50
75
100
Total 3–9 workers 10–24workers
25–49workers
50–199workers
200+ workers
2000 2008
Percent of firms offering health benefits
Source: The Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2000 and 2008 Annual Surveys.
Figure 6. Employer Coverage Continues to Be Major Source of Coverage for Employees of Larger Firms But Has Declined Among Small Firms
THE COMMONWEALTH
FUND
7Figure 7. Employer-Sponsored Insurance Coverage Declined
Among Small Firm Employees, 2003–2007
3525
70
22
24
1412
74
0
25
50
75
100
2003 2007 2003 2007
Employer Insurance - other
Employer Insurance - own
*Includes both part-time and full-time workers.Note: Subgroups may not sum to totals due to rounding.Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2003 and 2007).
Small Firms(fewer than 50 employees)
Percent of working adults ages 19–64*
Large Firms(50 or more employees)
85
4957
84
THE COMMONWEALTH
FUND
8Figure 8. Low-Wage Employees in Small Firms
Are Less Likely to Have Employer-Sponsored Insurance Coverage
2516
32
55
8324
22
30
12
13
11
74
0
25
50
75
100
Total <$15/hr $20/hr ormore
Total <$15/hr $20/hr ormore
Employer Insurance - other
Employer Insurance - own
*Includes both part-time and full-time workers.Note: Subgroups may not sum to totals due to rounding.Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
Small Firms(fewer than 50 employees)
Percent of working adults ages 19–64*
38
6862
94
Large Firms(50 or more employees)
85
49
THE COMMONWEALTH
FUND
9
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
MD
MEVTNH
MARI
CT
DE
DC
HI
CO
GAMS
OK
NJ
SD
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
ME
DE
DC
HI
CO
GAMS
OK
NJ
SD
19%–22.9%
Less than 14%
14%–18.9%
23% or more
1999–2000 2006–2007
MA
RI
CT
VTNH
MD
Figure 9. Percent of Adults Ages 18–64 Uninsured by State
Data: Two-year averages from the U.S. Census Bureau, CPS ASEC, 2000–2001 and 2007–2008; 1999–2000 estimates updated with 2007 CPS correction.
THE COMMONWEALTH
FUND
10Figure 10. 25 Million Adults Underinsured in 2007
60 Percent Increase Since 2003
Uninsuredduring the year
49.5(28%)
Insured all year, not
underinsured102.3(58%)
Insuredall year,
underinsured*25.2
(14%)
2007Adults ages 19–64
(177.0 million)
Uninsuredduring the year
45.5(26%)
Insured all year, not
underinsured110.9(65%)
Insuredall year,
underinsured*15.6(9%)
2003Adults ages 19–64
(172.0 million)
*Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income; medical expenses equaled 5% or more of income if low-income (<200% of poverty); or deductibles equaled 5% or more of income.Data: The Commonwealth Fund Biennial Health Insurance Surveys (2003 and 2007).Source: C. Schoen, S. R. Collins, J. L. Kriss, and M. M. Doty, “How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007,” Health Affairs Web Exclusive, June 10, 2008.
THE COMMONWEALTH
FUND
11Figure 11. Two of Five Adults Uninsured or Underinsured;
Percent Underinsured Triples for Middle-Income
26 28
49 48
13 16
914
19 24
411
0
25
50
75
100
2003 2007 2003 2007 2003 2007
Underinsured*
Uninsured during year
Total 200% of poverty or moreUnder 200% of poverty
*Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income, or 5% or more of income if low-income (<200% of poverty); or deductibles equaled 5% or more of income.Data: The Commonwealth Fund Biennial Health Insurance Surveys (2003 and 2007).Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
Percent of adults (ages 19–64) who are uninsured or underinsured
4235
17
27
6872
THE COMMONWEALTH
FUND
12Figure 12. Over Half of Working Adults in Small Firms Were
Uninsured or Underinsured During the Year, 2007
Firms with fewer than 50 employees39.0 million
Uninsured anytime36%
Underinsured16%
Adequately insured48%
Uninsured anytime15%
Underinsured13%
Adequately insured
73%
Firms with 50 or more employees76.9 million
^Includes both part-time and full-time workers.Underinsured is defined as having continuous health insurance coverage and spending 10 percent or more of income on out-of-pocket health care costs (or 5 percent or more if low income), or having deductibles of 5 percent or more of income.Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
THE COMMONWEALTH
FUND
13Figure 13. Deductibles Rise Sharply, Especially in Small Firms, 2000–2008
PPO = preferred provider organization. PPOs covered 57 percent of workers enrolled in an employer-sponsored health insurance plan in 2007.Source: The Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2000 and 2008 Annual Surveys.
187 210157
560
917
413
$0
$250
$500
$750
$1,000
Total Small firms, 3–199employees
Large firms, 200+employees
2000 2008
Mean deductible for single coverage (PPO, in-network)
THE COMMONWEALTH
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14Figure 14. Insurance Benefits Are Not As Generous
for Workers in Small Businesses
Percent of working adults ages 19–64 with own employer-sponsored insurance*
Fair or poor rating of insurance plan
No prescription drug coverage
*Includes both part-time and full-time workers.Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
48
9
23
37
3
16
0
25
50
75
<50 employees 50+ employees
Coverage limits total amount it will pay for medical care
THE COMMONWEALTH
FUND
15Figure 15. Underinsured and Uninsured Adults at High Risk of
Going Without Needed Care and Financial Stress
31
21
53
45
68
51
0
25
50
75
Went without needed care due to costs* Have medical bill problem or outstandingdebt**
Insured, not underinsured Underinsured Uninsured during year
Percent of adults (ages 19–64)
*Did not fill prescription; skipped recommended medical test, treatment, or follow-up, had a medical problem but did not visit doctor; or did not get needed specialist care because of costs. **Had problems paying medical bills; changed way of life to pay medical bills; or contacted by a collection agency for inability to pay medical bills.
Source: C. Schoen, S. Collins, J. Kriss, M. Doty, How Many are Underinsured? Trends Among U.S. Adults, 2003 and 2007, Health Affairs Web Exclusive, June 10, 2008. Data: 2007 Commonwealth Fund Biennial Health Insurance Survey.
THE COMMONWEALTH
FUND
16Figure 16. Uninsured and Underinsured Adults with Chronic
Conditions Are More Likely to Visit the ER for Their Conditions
33
2633
1519
32
4643
62 64
0
25
50
75
Skipped doses or did not fill prescription forchronic condition because of cost**
Visited ER, hospital, or both for chroniccondition
Total
Insured all year, not underinsured
Insured all year, underinsured
Insured now, time uninsured in past year
Uninsured now
Percent of adults ages 19–64 withat least one chronic condition*
*Hypertension, high blood pressure; heart disease; diabetes; asthma, emphysema, or lung disease.**Adults with at least one chronic condition who take prescription medications on a regular basis.Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
THE COMMONWEALTH
FUND
17Figure 17. Lack of Insurance Undermines
Preventive and Chronic Care
4653
50
32
0
20
40
60
80
100
Total Uninsuredall year
Uninsuredpart year
Insured allyear
Receipt of Recommended Screening and Preventive Care*, 2005
Percent of adults
81
41
63
21
0
20
40
60
80
100
Diabetes under control** High blood pressureunder control***
Insured Uninsured
Chronic Disease Under Control: Diabetes and Hypertension, 1999–2004
*Recommended care includes: blood pressure, cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot within a specific time frame given age and sex. **Refers to diabetic adults whose HbA1c is <9.0 ***Refers to hypertensive adults whose blood pressure is <140/90 mmHg.Data: Preventive care–B. Mahato, Columbia University analysis of Medical Expenditure Panel Survey; Chronic disease–J. M. McWilliams, Harvard Medical School analysis of National Health and Nutrition Examination Survey.Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
THE COMMONWEALTH
FUND
18Figure 18. Uninsured Adults and Adults with Gaps in Coverage
Have Lower Rates of Cancer Screening Tests, 2007
78
51
74
84
56
8177
35
6054
22
36
0
20
40
60
80
100
Received Pap test Received colon cancerscreening
Received mammogram
Total
Insured all year
Insured now, time uninsured in past year
Uninsured now
Percent of adults ages 19–64
Note: Pap test in past year for females ages 19–29, past three years age 30+; colon cancer screening in past five years for adults ages 50–64; and mammogram in past two years for females ages 50–64.Source: S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007, The Commonwealth Fund, August 2008.
THE COMMONWEALTH
FUND
19Figure 19. Cost-Related Problems Getting Needed CareHave Increased Across All Income Groups, 2001–2007
14
24
4041
29 29
45
6258
43
0
25
50
75
Total Low income Moderateincome
Middle income High income
2001 2007
*Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or follow-up; had a medical problem but did not visit doctor or clinic.Note: In 2001, low income is <$20,000, moderate income is $20,000–$34,999, middle income is $35,000–$59,999, and high income is $60,000+. In 2007, low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000+.Data: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2007).Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
Percent of adults ages 19–64 who had any of four access problems*in past year because of cost
THE COMMONWEALTH
FUND
20Figure 20. Problems with Medical Bills or
Accrued Medical Debt Increased, 2005–2007
20
32
4843
34
25
41
5356
39
0
25
50
75
Total Low income Moderateincome
Middle income High income
2005 2007
Note: Low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000+.Data: The Commonwealth Fund Biennial Health Insurance Surveys (2005 and 2007).Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
Percent of adults ages 19–64 with medical bill problems or accrued medical debt
THE COMMONWEALTH
FUND
21Figure 21. Medical Bill Problems and
Accrued Medical Debt, 2005–2007
2005 2007
In the past 12 months:
Had problems paying or unable to pay medical bills23%
39 million
27%
48 million
Contacted by collection agency forunpaid medical bills
13%
22 million
16%
28 million
Had to change way of life to pay bills14%
24 million
18%
32 million
Any of the above bill problems28%
48 million
33%
59 million
Medical bills being paid off over time21%
37 million
28%
49 million
Any bill problems or medical debt34%
58 million
41%
72 million
Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
Percent of adults ages 19–64
THE COMMONWEALTH
FUND
22
Insured All YearUninsured Anytime
During Year
Percent of adults reporting: TotalNo underinsured
indicatorsUnderinsured
Insured now, time uninsured in past
year
Uninsured now
Unable to pay for basic necessities (food, heat, or rent) because of medical bills
29% 16% 29% 42% 40%
Used up all of savings 39 26 46 46 47
Took out a mortgage against your home or took out a loan
10 9 12 11 11
Took on credit card debt 30 28 33 34 26
Insured at time care was provided
61 80 82 46 24
Figure 22. More Than One-Quarter of Adults Under Age 65 With Medical Bill Burdens and Debt
Were Unable to Pay for Basic Necessities
Source: M. M. Doty, S. R. Collins, S. D. Rustgi, and J. L. Kriss, Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families, The Commonwealth Fund, August 2008.
Percent of adults ages 19–64 with medical bill problemsor accrued medical debt
THE COMMONWEALTH
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23Figure 23. An Estimated 116 Million Adults Were Uninsured,
Underinsured, Reported a Medical Bill Problem, and/or Did Not Access Needed Health Care Because of Cost, 2007
Medical bill/ debt problem
17.7 million10%
Cost-related access problem
25.9 million15%
Source: S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007, The Commonwealth Fund, August 2008. The Commonwealth Fund Biennial Health Insurance Survey (2007).
Adequate coverage and no bill or access
problem61.4 million
35%
Uninsured anytime during the year or
underinsured17.6 million
10%
Medical bill/debt and cost-related access problem
54.4 million31%
177 million adults, ages 19–64
THE COMMONWEALTH
FUND
24
Data: Two-year averages 1999–2000, updated with 2007 Current Population Survey correction, and 2005–2006 from the Census Bureau’s March 2000, 2001 and 2006, 2007 CPS.
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
MD
MEVTNH
MARI
CT
DE
DC
HI
CO
GAMS
OK
NJ
SD
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
ME
DE
DC
HI
CO
GAMS
OK
NJ
SD
10%–15.9%
Less than 7%
7%–9.9%
16% or more
1999–2000 2005–2006
MA
RI
CT
VTNH
MD
Figure 24. CHIP Has Reduced Rates of Uninsured Children in Most StatesPercent of Children Ages 0–17 Uninsured by State
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 24
THE COMMONWEALTH
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25Figure 25. Low-Income Workers Are Eligible for COBRA at Only
Half the Rate of Higher-Income Workers
Below 200% FPL
COBRA-eligible 38%
Ineligible, insuredbut not through
employer27%
Ineligible,uninsured
33%
200%+ FPL
Ineligible, small-firm worker
3%
Source: M. Broaddus et al., Measures in House Recovery Package—But Not Senate Package—Would Help Unemployed Parents Receive Health Coverage (Washington, D.C.: Center on Budget and Policy Priorities, February 2009); M. M. Doty et al., Maintaining Health Insurance During a Recession: Likely COBRA Eligibility (New York: The Commonwealth Fund, January 2009).
COBRA-eligible 76%
Ineligible, insuredbut not through
employer11%
Ineligible,uninsured
7%
Ineligible, small-
firm worker6%
THE COMMONWEALTH
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26Figure 26. Even With ARRA Subsidies, COBRA Still Unaffordable
for Individuals and Families at 150 Percent of Poverty
$4,704
$12,680
$1,646
$4,438
$1,560$2,640
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
Individual Family
Full COBRA Premium Unsubsidized Amount 10% Income
Source: M. Broaddus et al., Measures in House Recovery Package—But Not Senate Package—Would Help Unemployed Parents Receive Health Coverage (Washington: Center on Budget and Policy Priorities, February 2009).
THE COMMONWEALTH
FUND
27Figure 27. Average Family Premium as a Percentage
of Median Family Income, 1999–2020
11%12%
13%
14%
16%17%
18%18%18% 18%19%19%19%20%20%21%21%
22%22%
23%24%
18%
0%
5%
10%
15%
20%
25%
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, The Commonwealth Fund, August 2009.
Projected
THE COMMONWEALTH
FUND
28Figure 28. Average Annual Savings per Family
Under Health Reform That Controls Premium Growth, 2020
$2,314
$1,547
$1,857$2,103 $2,202
$2,559$2,426
$2,612 $2,624
$2,961
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
Family Income ($ thousands)
Savings in health care spending compared with projected trends
Data: Estimates by The Lewin Group for The Commonwealth Fund.Source: The Commonwealth Fund Commission on a High Performance Health System, The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way (New York: The Commonwealth Fund, February 2009).