by Lisa Codispoti, Senior Advisor
and Brigette Courtot, Policy Analyst
National Women’s Law Center
This post is part of a weekly series on Women and Health Reform.
A new study released this week by the Commonwealth Fund reminds us that health insurance is not simply about the “haves” and the “have-nots”. The study takes a closer look at the growing population of Americans who fit somewhere in between. They are known as the “underinsured” and while they do have some sort of health insurance, their coverage still exposes them to significant financial risk. The underinsured spend a big chunk of their income on health care; for example, a moderate-income woman with insurance who spends at least 10 percent of her income on medical expenses is underinsured. As noted in today’s New York Times editorial, the health coverage that underinsured people have is “pitifully inadequate.” It erodes family finances and doesn’t provide protection from catastrophic medical costs.
From 2003-2007, the number of underinsured Americans increased by 60 percent; this startling figure got a lot of press coverage. What didn’t get as much attention is this: when we looked at details of the study, we found women are disproportionately represented among the underinsured. This sad fact didn’t come as a big surprise, and we can make some educated guesses about why this might be the case. The underinsured are more likely to purchase their coverage in the individual insurance market (as opposed to getting it through an employer), and we know that more women than men get insurance this way. Underinsured adults with job-based coverage are also more likely to work in low-wage or small firms, and we know these types firms typically employ more women than men. Finally, women earn less and are poorer than men, in general. They also need and use more health care, so it follows that they would be more likely to spend a larger share of their (already lower) income on that care.
The swell in underinsured rates is a direct consequence of cost-shifting, which happens when insurers and employers make us cover an increasing share of health care costs – typically through high deductibles, copayments, or coinsurance. It’s an unwelcome trend in the way some new health insurance products are being designed, with the rationale that when people are exposed to a greater share of costs, they will be wiser health care consumers, which will presumably lead to a more efficient and cost-effective health care system. But cost-shifting is only making the national health care crisis worse. Underinsured adults are almost as likely as the uninsured to go without needed care because they cannot afford it, including skipping doses of medication or not seeing a doctor when sick. Nearly as many underinsured adults as uninsured adults report high levels of financial stress due to medical bills.
This study sure didn’t make us feel any better about the direction our health system is currently moving in, but we do welcome the spotlight on the underinsured. As we advocate for progressive health reform that will give women access to the health care they need, we must be mindful that simply having health coverage is not enough. What good is having health insurance if you face bankruptcy when you get sick? In our efforts to extend health insurance to Americans that have none, we must be careful to promote coverage that is comprehensive and affordable rather than coverage that will only add to the ranks of the underinsured.
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