SECURITY MATTERS:HOW INSTABILITY IN HEALTH INSURANCE

PUTS U.S. WORKERS AT RISK

FINDINGS FROM THE COMMONWEALTH FUND2001 HEALTH INSURANCE SURVEY

CHARTS

One of four adults—38 million—was uninsured during the past year.

161.3 Million Adults Ages 19–64

Insured Now, Time

Uninsured in Past Year

9%

Uninsured When Surveyed

15%

Insured All Year76%

Most uninsured adults have low family incomes.

Less than$20,000

56%

Uninsured Now 23.8 million

$20,000–$34,999

19%Less than $20,000

44%

$20,000–$34,999

19%

$35,000–$59,999

12%$35,000–$59,999

22%$60,000or More

2%

$60,000 or More7%

Unknown11%

Unknown8%

Insured Now,Time Uninsured in Past Year

14.5 million

Length of Time Uninsured, Adults Ages 19–64

4 to 11 Months

38%

1 Year or More

75%

Don’t Know2%

Don’t Know 1%

Uninsured Now

Insured Now,Time Uninsured in Past

Year

4 to 11 Months

12%

3 Monthsor Less

11%

3 Monthsor Less

36%

1 Year or More

25%

Nearly half of low-income adults were uninsured during the year as of July 2001.

15%

33%

17%

30%

6%

16%16%

6%

6% 3%

7%

11%9%

0%

25%

50%

Total Less than$20,000

$20,000–$34,999

$35,000–$59,999

$60,000 orMore

Below200%

Poverty

200%Poverty or

More

Uninsured now Insured now, time uninsured in past year

24%

46%

12%

49%

28%

13%

4%

Young adults and Hispanics are at high risk forbeing uninsured.

24%16%

10% 9%

33%

14% 11%

15%

12%

5%8%

13%

6%

10%

0%

25%

50%

19–29Years

30–39Years

40–49Years

50–64Years

Hispanic Black White

Uninsured now Insured now, time uninsured in past year

39%

26%

16%14%

45%

27%

19%

Why are you uninsured now? Why were you uninsured earlier in the year?

45%

14%

19%

7%

15%

29%

1%

26%

14%

30%

0%

25%

50%

TooExpensive,Can't Afford

Lost orChanged Jobs

EmployerDoes Not Offer

or Ineligible

Do Not NeedInsurance

Other

Uninsured now Insured now, time uninsured in past year

Most uninsured workers are not offered or eligible to participate in job-based coverage.

Currently Uninsured Working Adults Ages 19–64

Employer Offers, But Not Eligibleto Participate

11%

Offered andEligible

22%

Employer Doesn’t Offer Health Plan

60%

Don’t Know4%Offered, Don’t

Know If Eligible3%

Adults with any time uninsured in the past year are two tofour times more likely to have access problems than those insured all year.

34%

43%

55%

30%25%

35%

26% 27%31%

52%

10%9%13%

7%

21%

0%

20%

40%

60%

Did Not Fill aPrescription

Did Not SeeSpecialist When

Needed

Skipped MedicalTest, Treatment,

or Follow-Up

Did Not SeeDoctor When

Sick

Any of the FourAccess Problems

Uninsured now Insured now, time uninsured in past year Insured all year

Percent of adults who went without needed care in the past year due to cost

Over half of adults uninsured during the year had problems paying medical bills.

50%

36%

27%

56%

9%

55%

31%

37%

44%

17%

24%

15%

0%

20%

40%

60%

Unable to PayMedical Bills

Contacted byCollection Agency

Had to ChangeWay of Life to Pay

Medical Bills

Any of the ThreeMedical BillProblems

Uninsured now Insured now, time uninsured in past year Insured all year

Financial Insecurity Due to Medical BillsAmong Adults Ages 19–64

TotalUninsured

Now

Insured Now,Time

Uninsured in Past Year

Insured All Year

Had to change way of life to pay bills

13% 27% 31% 9%

Ways adults had to change life

Used all or most of savings

70 70 76 68

Borrowed money from family or friend

58 64 70 49

Unable to pay for basic necessities

54 55 61 51

Needed loan or mortgage home

23 27 26 19

Difficulty Meeting Basic Needs Within Last Year

40%

22%

39%

24%

12%7%

0%

20%

40%

60%

Could Not Pay for Basic Living Costs,Such as Food, Rent, Heating or

Electric Bills

No Telephone Service for at LeastTwo-Week Period

Uninsured now Insured now, time uninsured in past year Insured all year

Percent of adults reporting:

More than one of four uninsured adults had topay cash in advance for medical care.

27%29%

14%17%

0%

15%

30%

Total Uninsured Now Insured Now,Time Uninsured

in Past Year

Insured All Year

Percent of adults who had to pay cash in advance for medical care

Regular Source of Care and Doctor Ratings, by Insurance Status, Adults Ages 19–64

TotalUninsure

d Now

Insured Now, Time

Uninsured in Past Year

Insured All Year

Have regular doctor yourely on for care

76% 42% 69% 84%

With current source ofcare five years or more

51% 38% 35% 55%

Rating of quality of physician care

Excellent or very good

67% 43% 63% 72%

Good 23% 33% 28% 20%

Only fair or poor 8% 18% 7% 6%

Thinking about your future medical care needs, how confident are you that you will be able to get high-quality health care when you need it?

Not at AllConfident

10%

Not TooConfident

15%

Somewhat Confident

41%

VeryConfident

32%

Don’t Know2%

Adults Ages 19–64

Low-income adults ages 19 to 64 are more likely to lack confidence they will get high-quality care when needed.

0%

20%

40%

Total Less than$20,000

$20,000–$34,999

$35,000–$59,999

$60,000 orMore

25%

16%

36%

26%

22%

Percent of adults not too or not at all confident about getting high-quality care

Adults with any time uninsured lack confidence in their ability to get high-quality care when needed.

25%

47%

31%

20%

0%

20%

40%

60%

Total Uninsured Now Insured Now,Time Uninsured

in Past Year

Insured All Year

Percent of adults not too or not at all confident about getting high-quality care

Lack of insurance for any family member increases family risk of financial insecurity due to medical bills.*

TotalAll

Uninsured Now

Some Insured,

Some Not Insured

All Continuously

Insured

Total adults with families

4% 23% 73%

Financial Experiences

Medical bill problems in past year

Not able to pay medical bills

25 58 47 16

Contacted by collection agency for medical bills

22 44 38 15

Had to change way of life significantly to pay bills

14 37 27 9

At least one of three types of medical bill problems

33 62 56 25* Based on adults ages 19–64 who are married and/or have a child/children.

Low-income workers are much less likely to have employer-based insurance coverage.

86%

48%

74%

40%

75%

90%85%

0%

25%

50%

75%

100%

Total Less than$20,000

$20,000–$34,999

$35,000–$59,999

$60,000 orMore

Below200%

Poverty

200%Poverty or

More

24%

12%

28%

13%

4%

Percent of workers who have employer-based insurance

Working adults with low incomes are much more likely to experience access or medical bill problems.

35%32%

59%

24%

52%57%

40%

0%

20%

40%

60%

Total Less than$20,000

$20,000–$34,999

$35,000–$59,999

$60,000 orMore

Below200%

Poverty

200%Poverty or

More

28%

Percent of workers who had an access or bill problem in the past year

Lower-income workers are at risk for access and medical bill problems, if uninsured.

33%

39%

50%

6% 6%

30%27%

18%

9%11%

16%

22%

10%5%

11%

0%

20%

40%

60%

Did Not Fill aPrescription

Did Not SeeSpecialist When

Needed

Skipped MedicalTest, Treatment,

or Follow-Up

Did Not SeeDoctor When

Sick

Not Able to PayMedical Bills

Lower-income* uninsured Lower-income insured** Higher-income insured

Percent of workers who had the following problems in the past year due to cost

* “Lower-income” is defined as having annual family income of less than $35,000.** “Insured” is insured all year.

Likely COBRA Eligibility of Workers Ages 19–64

ESI* Small Firm

10%

COBRA-EligibleESI Firm > 25 Employees**

65%

Uninsured13%

Other Insurance 12%

* Employer-sponsored insurance coverage.

** The survey defines small firms as having fewer than 25 employees; thus, the analysis may underestimate COBRA eligibility.

Ineligiblefor

COBRA

Below 200% Poverty 200% Poverty or More

Other Insurance

8%

Uninsured

32%

COBRA-Eligible

75%

ESISmall Firm11%

ESI*Small Firm

8%

Other Insurance 20%

COBRA-Eligible

40%

Uninsured

6%

* Employer-sponsored insurance coverage.

COBRA Eligibility Working Adults, Ages 19–64

Reports on Individual Market ExperiencesBase: Adults who have bought or tried to buyindividual insurance in the past three years

Total 19–29 30–39 40–49 50–64

Percent in individual marketin the past three years

27 33 30 26 21

How difficult was it to find a plan with the type of coverage you needed?

Very/somewhat difficultor impossible

52 54 54 49 51

Not too/not at all difficult 38 36 38 41 36

How difficult was it to find a planyou could afford?

Very/somewhat difficultor impossible

69 64 74 71 71

Not too/not at all difficult 23 27 23 21 21

Did not end up buying a plan 71 73 72 69 69

Adults with employer-sponsored plans think employersgenerally do a good job of selecting quality health plans.Percent of adults with employer-based coverage who said employers:

Do a Good Job74%

Do a Bad Job13%

Do a Mixed Job10%

Don’t Know3%

If your employer stopped offering coverage, how confident are you that you would be able to find an affordable health plan that meets your needs?

Percent with employer-based coverage who said:

Not at AllConfident

26%

Not TooConfident

21%

Somewhat Confident

29%

Very Confident18%

Preferences About Potential Changes in Employer Coverage Arrangements

Adults with Employer-Sponsored Insurance

If you could get a tax credit of ($1,000 for single/$2,500 for family), would you DROP the employer plan and get insurance on your own, or would you KEEP the employer plan and give up the tax credit?

Some employers are thinking of giving the money they pay for health insurance directly to employees so employees can buy insurance on their own. Which would you prefer?

Take Tax Credit; Drop Plan19%

Keep Employer

Plan68%

Continue with

Employer Plan78%

Get Employer

Contribution;

Buy Own Plan17%

Depends13%

Don’t Know5%

Adults with employer-based coverage generally prefer keeping it. But younger adults are somewhat more likely to consider taking an option to leave group plans.Alternative insurance arrangements

Total19–29

30–39

40–49

50–64

Get a tax credit ($1,000/single; $2,500/family) to get insurance on your own

Percent very or somewhat likely to:

DROP employer plan for tax credit

19 26 20 17 14

KEEP employer plan 68 61 65 68 76

Employer gives money for insurance directly to employees to buy coverage on their own

Percent with preference to

Take contribution and find own plan

17 22 19 15 13

Continue with employer plan 78 73 75 79 82

Of those with employer coverage, interest in droppingthis coverage for a tax credit* to purchase insurance on one’s own is low overall, but declines with income.

68%

58%64%

69%73%

14%21%21%

30%

19%

0%

30%

60%

90%

Total Less than$20,000

$20,000–$34,999

$35,000–$59,999

$60,000 orMore

Keep employer plan Drop coverage; take tax credit

* $1,000/single; $2,500/family.

Percent who are very or somewhat likely to… ...if offered a tax credit:

Those with employer coverage generally prefer continuing this coverage over getting an employer contribution to find their own plan.

78%69%

78% 75%84%

13%19%17%

26%17%

0%

30%

60%

90%

Total Less than$20,000

$20,000–$34,999

$35,000–$59,999

$60,000 orMore

Keep employer plan Get contribution and find own plan

Percent who prefer to…

Support for Proposals to ExpandHealth Insurance Coverage

Percent of adults in favor of: Total

Letting uninsured adults participate in state governmentinsurance programs that are for people with low income

82%

Letting uninsured adults participate in Medicare 77%

Offering tax credits or other financial assistance to helppeople buy health insurance on their own

81%

Requiring all businesses to contribute to the cost ofhealth insurance for their employees

82%