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Cathy Schoen, Michelle M. Doty, Sara R. Collins, and Alyssa L. Holmgren, Insured But Not Protected: How Many Adults Are Underinsured?, Health Affairs Web Exclusive, June 14, 2005 [Abstract] [PDF] [HTML Version] [Reprints & Permissions]

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Article Hits Home

David L. Koch   ( 14 June 2005 )

Underinsurance Peaks During Early Adulthood?

Archie Bleyer   ( 15 June 2005 )

Underinsured Young Adults: The Authors Respond

Cathy Schoen   ( 15 June 2005 )

Let's Get Efficient in Health Care Delivery Instead of Blaming Inadequate Insurance

Rahul Gupta, Seema Gupta, MD   ( 23 June 2005 )

Article Hits Home 14 June 2005
David L. Koch, Account Manager None Send comment to journal: Re: Article Hits Home Dave.koch{at}ACRAnet.com David L. Koch	Thanks for your article and study. It hits very close to home for me. My 18-year-old son has been stricken with cancer twice in the last five years. During that time my insurance premiums have more than tripled and my coverage has shrunk to nothing. In 2004 while my son was recovering from a brain tumor but after his surgery, my out-of-pocket costs, including insurance premiums, topped $14,000. Only $700 of this out-of-pocket cost was applied to the $1,500 per person, $5,000 per family deductible. This out-of-pocket cost did not include his chemotherapy, which would have been $40,000 additional not covered by my insurance had we not gotten aid from the drug manufacturer. I have abandoned all health care and dental care for myself except for emergencies. The last straw was when the three-month cost for my arthritis prescriptions jumped from $90 last December to $277 in January. It is a crime that people can work hard and do everything right but lose everything in the end.
Underinsurance Peaks During Early Adulthood? 15 June 2005
Archie Bleyer, Medical Advisor St. Charles Medical Center Send comment to journal: Re: Underinsurance Peaks During Early Adulthood? ableyer{at}scmc.org Archie Bleyer	It's a shame that Cathy Schoen and her coauthors did not analyze their data as a function of patient age. The rather high rate of uninsurance they reported must be at its worst among 18 to 29 year-olds.
Underinsured Young Adults: The Authors Respond 15 June 2005
Cathy Schoen, Vice President The Commonwealth Fund Send comment to journal: Re: Underinsured Young Adults: The Authors Respond cs{at}cmwf.org Cathy Schoen	We agree that young adults are at high risk. We refer readers to Exhibit 2 of the article to see the distribution by age. As illustrated, nearly half -- 49% -- of young adults (ages 19-29) were either underinsured or uninsured. This high rate is largely the result of very high rates of young adults who have a time without any insurance during the year. In the study, about 9% of all young adults were underinsured and another 40% uninsured. Among young adults who were insured all year (only 60% of young adults had insurance all year), 16% were underinsured based on expenses during the year and plan deductibles. (See Exhibit 2, column 4.) This was the highest underinsurance rate among the age groups. As the article indicates, our methodology emphasizes expenses during the year. Thus, this estimate may well underestimate adults at risk because of benefit gaps or cost sharing in their insurance policies who remained healthy all year and thus did not incur medical bills. We thank the reader for drawing attention to the risks in this age group.
Let's Get Efficient in Health Care Delivery Instead of Blaming Inadequate Insurance 23 June 2005
Rahul Gupta, Assistant Professor of Medicine University of Alabama-Birmingham School of Medicine - HRMC, Seema Gupta, MD Send comment to journal: Re: Let's Get Efficient in Health Care Delivery Instead of Blaming Inadequate Insurance drgupta{at}uab.edu Rahul Gupta, et al.	We agree with and applaud the authors’ broader conclusion that many Americans really need better health coverage than under the current system. However, there is a serious flaw to the methodology used to obtain these figures. The authors rely not on real data like patient charts but a telephone survey to obtain the details of illness. As an example, a frustrated patient with frequent migraine headache (disabling and difficult to treat) may have stated his/her illness as very severe compared with a patient with early cancer who could really get a cure if he/she had appropriate insurance. Also, the respondents had a much higher percentage (36 percent) of health problems or disability. No verification was performed for insurance or illnesses stated. Furthermore, the authors fall short of providing the understanding that people purchase insurance because they prefer certainty of paying a small premium to the risk of getting sick and paying a large medical bill. Also, the additional health care that consumers purchase above the minimum insurance is not without the cost of producing it. Therefore, the theory of higher cost sharing in fact reduces spending and reduces consumption.[1] On the other hand, universal access to health services and their provision free of charge do not automatically guarantee equity and efficiency. Equity means that the same treatment is applied to everybody. Efficiency means that health expenditures are kept under control, taking into account the health results obtained. In this respect, our nation is ranked at the lowest level, whatever the classification system used. Therefore, the focus should be to improve access for the most needy amongst us and make our health care delivery system -- including the insurance industry -- more efficient and accountable, not go after them. REFERENCE: 1. Keeler EB, “Effects of cost sharing on use of medical services and health”, Medical Practice Management, 1992