The Medically Uninsured

What's the Problem?

Prior to 2014, over 41 million non-elderly Americans were uninsured. Not having health insurance makes a difference in people’s access to needed medical care and their financial security. The barriers the uninsured face means they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact can also be severe. Uninsured families already struggling financially to meet basic needs can quickly gain insurmountable levels of medical debt from medical bills, even for minor problems.

Who's at Risk?

Most of the uninsured come from working families, but make too much to qualify for government insurance programs like Medicaid. Young adults, particularly those ages 18-35, find it difficult to afford coverage, are often not interested in coverage, do not understand the value of health insurance, and are likely to be uninsured. Children without health insurance coverage are less likely to have a regular source of health care or access to prescription medicines.

Can It Be Prevented?

According to a 2012 Kaiser Family Foundation report, over the next ten years, the Affordable Care Act (ACA) is expected to reduce the number of uninsured by more than half. The ACA will fill existing gaps in coverage by: allowing for expanded access to the Medicaid program for those at or below 138% of the federal poverty level, providing incentives for more employer-based coverage, and providing subsidies to many non-Medicaid eligible individuals and families (with incomes between 100% of 400% of the federal poverty level) to make the purchase of private insurance more affordable. Other key aspects of the ACA include: insurance companies will not be able to deny someone coverage for a pre-existing condition and they also will not be able to impose annual or lifetime policy coverage limits on coverage of essential health benefits.

The Bottom Line to Consumers

• Not having healthcare coverage can be financially ruinous; there are options for the uninsured that did not previously exist including free or low cost premium plans for those whose incomes qualify.
• New options for health insurance, and access to these options, were made available to the public beginning October 1, 2013 through the Health Insurance Marketplace. Through this online shopping destination, consumers can see what financial help they may qualify for and shop for private plans in one online location.
• The Marketplace offers several kinds of assistance to help consumers apply for coverage and choose a plan that meets their needs: online questions and answers, online chat, a toll-free call center, and people in the community trained to help consumers apply and enroll.
• In all states, there are people trained and certified to help consumers understand health coverage options and enroll in a plan. They are known by different names, depending on who provides the service and where they are located. All provide similar kinds of help: Navigators, Application assisters, certified application counselors and Government agencies, such as State Medicaid and Children’s Health Insurance Program (CHIP) Offices. Insurance agents and brokers can also help consumers with their application and choices.
• Insurance companies will not be able to turn down those with a pre-existing condition for health insurance.
• Insurance companies cannot dump a policy holder based on reaching any annual or lifetime coverage limit.
• Every child should have access to health care coverage. Many families are eligible for health care coverage for their children right now. If a plan covers children, they can be added to or kept on a parent's health insurance policy until they turn 26 years old.
• A consumer won’t be charged more for health insurance just because she is a woman.

Case Examples

1. A 40-year-old working single mom, with no health insurance through her employer and unable to afford health insurance for herself, is only able to take advantage of some of the free community health care services available to her: free screenings for high blood pressure, diabetes, and cholesterol. She has a family history of high blood pressure, high cholesterol, and type II diabetes. Her most recent screenings indicate she, too, is most likely suffering from type II diabetes along with high blood pressure and high cholesterol. She cannot afford the repeated visits to a doctor’s office or the medications necessary to treat her condition. The stress of the situation has caused her to have an apparent heart attack, landing her in the emergency room. She’s going to be okay for now, but the on-call physician tells her she will need to promptly begin treating her multiple conditions. She tells him she doesn’t have insurance and is terrified to think how she’s going to pay for treatment for the rest of her life. Starting in 2014, he will be able to refer her to the hospital’s financial counselor who informs her of some of the more economical plans that are available to folks just like her via the Health Insurance Marketplace. She cannot be denied coverage based on her pre-existing conditions, and she may also qualify for a sizeable subsidy.
2. A 28-year-old young man, still living at home with his parents and no longer covered under his parent’s health insurance policy, is returning home from his part-time job when he loses control of his motorcycle on a slippery road. He is rushed to the hospital unconscious with multiple fractures to his legs. To stabilize him, the medical staff places him into an induced coma. Despite wearing a helmet, he has suffered injuries to his head. The extent of the damage to his brain is unknown and he could be in intensive care for an extended period of time. The parents are terrified, but are partially relieved to know at least he’s still alive. They stay by his bedside every minute of every day for a week until he finally regains consciousness with no apparent brain injury. They are ecstatic to know he will most likely make a full recovery, but then realize they are saddled with a bill for over $100,000, as the auto policy for their son will only pay a portion of the total hospital bill. In 2014, the young man could have defrayed the costs for himself, or his parents, by purchasing a health care insurance plan that contained catastrophic coverage through the Health Insurance Marketplace. To assist with the cost of purchasing health care insurance, there are many financial assistance options for those that qualify.