On August 26, the US Census Bureau released the news that although the number of Americans living without healthcare insurance, and the level of medical care that insurance promises, has dropped by 1.3 million since 2006, there were, nevertheless, 45.7 million Americans still without health insurance coverage in 2007.

Of that 45.7 million Americans without health insurance, 8.1 million of them were children.  For the sake of census bureau purposes, to be insured means having available any form of health insurance, including employer-linked private plans, insurance purchased directly, or insurance supplied by the federal government, including Medicaid, Medicare, and the military.

Karen Davis, PhD, however, warns that simply having access to medical insurance does not mean high medical bills can be avoided nor does it mean adequate medical care will be provided.  Davis, a healthcare economist, is president of the private foundation, The Commonwealth Fund.

Davis is as concerned about the nation’s underinsured citizens as she is worried about those with no insurance coverage at all.  In just two years, the number of US adults who are underinsured rose from 16 million to 25 million.  Underinsured means a person has access to coverage but income is so low that he or she cannot afford the out-of-pocket expenses, such as deductibles, premiums, and co-payments, that make medical insurance coverage work.

For that 45.7 million Americans without health insurance, medical care doesn’t happen for free, a point recently reported by Jack Hadley, PhD, and his colleagues at the George Mason University.  In the August 25 issue of Health Affairs, Hadley reports an estimated expenditure of $30 billion in out-of-pocket medical costs to be paid by people with no medical insurance in 2008.  Thirty billion dollars, however, isn’t enough to cover all medical expenses accrued by uninsured Americans.  The US government is expected to foot the bill for the remaining $56 billion in healthcare costs to uninsured Americans this year.

Both Davis and Hadley describe our current healthcare system as troubled, largely because health care in the US is so strongly linked to employment and the health insurance coverage provided by employers.  This form of insurance is dwindling and covers little more than half the US population at best.  In 2006, 59.7% of the population was covered under employment-based medical insurance plans.  That rate dropped to 59.3% for 2007 but that number, too, is expected to drop as time goes by.

To make matters even more troubling, Davis says there is a disparity in the quality of care given to insured patients versus that given to the underinsured.  She cites a recent study that revealed a much worse outcome for underinsured patients suffering from heart attacks compared to their fully insured counterparts, even when immediate care to both groups was basically the same.

Further disparities in health insurance coverage in 2007 include:

  • Uninsured Hispanics number 32.1% of the population;
  • 19.5% of blacks are uninsured;
  • 16.8% of Asians have no insurance;
  • 10.4% of the white population is not insured.

Because the American Indian/Alaska Natives and Native Hawaiians/Pacific Islander populations are so small, compared to the general US population, the rates of insurance availability in these groups was based on a three-year average using census data from 2005 to 2007.  Even when averaging the data, the rate of uninsured in these groups is large:

  • 32.1% of the American Indian/Alaska Natives have no medical insurance, while
  • 20.5% of the Native Hawaiians/Pacific Islanders have no medical insurance coverage.

Household income is a strong determining factor where medical insurance coverage is concerned:

  • 24.5% of all households earning less than $25,000/year are not insured;
  • 21.1% of those earning $25,000 to $49,999 are uninsured;
  • 14.5% of those earning between $50,000 and $74,999 are uninsured; and
  • 7.8% of all Americans making $75,000 and more are uninsured.

Source: US Census Bureau