On November 21, leaders of The Commonwealth FundThe New York City-based public interest foundation released its latest report on consumers’ health insurance coverage, a biennial report called “The State of U.S. Health Insurance in 2024: Results from the Commonwealth Fund Biennial Health Insurance Survey.” The report reveals significant challenges around health insurance coverage for Americans, including the key issue of underinsurance.
The Commonwealth Fund press release, posted on the organization’s website Thursday morning, began: “The Affordable Care Act (ACA) and recent reductions in marketplace premiums have driven uninsured rates in the United States to historic lows, with the majority of Americans in working age covered throughout the year. However, a new Commonwealth Fund survey shows that coverage gaps persist and that health plans (including those offered by employers, which cover most people) do not always ensure affordable or timely access to care. The report suggests ways policymakers can expand coverage and reduce costs for consumers.”
On behalf of The Commonwealth Fund, SSRS, a survey company, interviewed 8,200 adults ages 19 to 64, and Commonwealth Fund experts analyzed 6,400 survey responses. Based on their analysis, Commonwealth Fund leaders were able to determine that 23 percent of insured respondents were underinsured, which they defined as “enrolled in health plans with high out-of-pocket costs that make it difficult to pay for insurance.” attention”. Among those underinsured,” the Commonwealth Fund noted, “two-thirds (66 percent) had coverage through an employer, 14 percent had individual or marketplace plans, and 11 percent were enrolled in Medicaid. More than half (57 percent) reported having given up on health care due to cost and 44 percent said they have medical debt.”
There were numerous key findings, including the following
EITHER Two-thirds of underinsured adults (66 percent) are covered through an employer-provided health plan.
EITHER More than half of adults who were uninsured or underinsured reported skipping recommended treatments or not filling prescriptions because of cost.
EITHER Up to one-third of people with a chronic illness, such as heart failure and diabetes, chose not to fill prescriptions for their health problems due to cost.
EITHER More than one-third of working-age adults who were uninsured or underinsured are paying off medical or dental debt, forcing many to delay or avoid needed care, forgo essential needs, and experience stress.
EITHER Nearly half (48 percent) of all adults with medical debt owe $2,000 or more; one in five (21 percent) have a staggering debt of $5,000 or more.
EITHER About half (51 percent) of adults with debt said it was due to treatment they received for a chronic health condition; Hospital care was cited as the most common source of debt (49 percent).
EITHER Delaying or skipping care is harming people’s health. Two in five adults (41 percent) who skipped or delayed needed care because of cost said their health problem had worsened as a result. This was especially true for people who were in poor health and had lower incomes (45 percent).
Joseph R. Betancourt, MD, MPH, president of The Commonwealth Fund, made a statement at the beginning of a press conference held online on Wednesday, November 19, prior to the official release of the survey results. “Our biennial health insurance survey provides a broad view of Americans’ experiences with health insurance, including the quality of their coverage,” said Dr. Betancourt. “What it reveals is a critical weakness in the U.S. health insurance system: Even with coverage, too many Americans still struggle to afford the care they need. We are in a unique moment in 2024. Thanks to the Affordable Care Act and recent expansions of premium subsidies for marketplace plans, more Americans than ever have coverage; the uninsured rate is at an all-time low. People with pre-existing conditions can access coverage without discrimination and preventive care is available at no cost. These are very real and important achievements. However, having health insurance does not always mean access to affordable and timely care.”
In fact, Betancourt said, “Our findings underscore how the high cost of coverage in most insurance plans is affecting people every day. And with so many insured Americans facing such high out-of-pocket costs and deductibles, they are forced to incur medical debt and even skip needed care altogether. I will say that this is not just a health problem, it is economic; When people are forced to spend a significant portion of their income on healthcare without adequate protection, they often fall into debt and are forced to choose between their health and their financial security. Personally, as a primary care physician, I see firsthand how these critical gaps in coverage are not just national data points; They are impacting individual lives. I regularly care for patients struggling to pay for essential medications, fight denied claims for the care they need; I see older patients who have had to deal with this over the years and because they didn’t have adequate coverage before Medicare, they are now sicker and costing our healthcare system more because of it. Looking ahead, especially as we face a new Congress and administration, we hope these findings will help advance clear policy solutions to address these challenges and the lived experiences of millions of Americans.”
The report was written by Sara R. Collins, Ph.D., senior scholar and vice president of healthcare coverage and access, and Avni Gupta, Ph.D., healthcare coverage and access researcher, both at The Commonwealth Fund.
The press release notes that “policy options that could provide better coverage to more people include:
EITHER Permanently extend the enhanced marketplace premium tax credits, introduced during the COVID pandemic, which are set to expire in 2025. Without these credits, annual premium costs for consumers in marketplace plans will increase by an average of $705 and estimates that 4 million could lose coverage.
EITHER Remove medical debt from credit reports and apply stricter requirements to hospitals to prevent patients from accumulating debt.
EITHER Lower deductibles and out-of-pocket costs on Marketplace plans.
EITHER Adjust premiums and cost-sharing in employer plans based on workers’ income to make coverage more affordable and comprehensive for lower-wage employees.
EITHER Establish a federal alternative option to cover the approximately 1.5 million uninsured people in the 10 states that have not expanded their Medicaid programs.
EITHER Allow states to maintain continuous Medicaid eligibility for adults for 12 months, as has been done for children in Medicaid and the Children’s Health Insurance Program. “This would help avoid gaps in coverage due to eligibility changes, administrative errors and other factors that can leave people uninsured and unable to receive care.”
The full report can be accessed here.
As explained on the organization’s website“The Commonwealth Fund was established in 1918 with the overall objective of improving the common good. Its founder, Anna M. Harkness, is among the first women to start a private foundation. Today, the Commonwealth Fund’s mission is to advance an equitable, high-performing health care system that achieves better access, better quality, and greater efficiency, particularly for society’s most vulnerable, including people of color, people with low incomes and those who are uninsured. The Fund carries out this mandate by supporting independent research on health care issues and providing grants to improve health care practices and policies. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.”
