« Disingenuous? Ya think?| Main | Oregon Governor's proposed budget provides additional $700 million for health care »


Researchers Use Income Of Three Times Poverty Level As Affordability Threshold; Alternative Measures Show Coverage Out Of Reach For Even More Uninsured People

Bethesda, MD -- More than half of the nation's uninsured residents are ineligible for public programs such as Medicaid but do not have enough resources to purchase coverage themselves, researchers from the Urban Institute report in a Health Affairs Web Exclusive published today. The report was funded by the Robert Wood Johnson Foundation.

Of the 44.6 million uninsured Americans, 56 percent are ineligible for public programs and have insufficient incomes to afford coverage on their own, the researchers report. Another 25 percent of the uninsured are eligible for public programs, and the remaining 20 percent have incomes high enough to afford coverage.

"Sometimes you hear arguments that all but a small minority of the uninsured could either purchase coverage or are already eligible for assistance," said lead author Lisa Dubay, now a research scientist at the Johns Hopkins Bloomberg School of Public Health. "But our study shows that the affordability problem is far more serious than that."

Affordability Barriers Loom Largest For Childless Adults

Childless adults, who are generally not covered under Medicaid, the State Children's Health Insurance Program (SCHIP), and other public programs, face the most severe affordability barriers. Of the 25.5 million uninsured childless adults in the United States, 69 percent are ineligible for public programs but cannot afford coverage on their own. The affordability barriers facing uninsured parents are only slightly less severe: Of 11.1 million uninsured parents, 56.9 percent cannot afford coverage and have no access to public assistance, according to Dubay and her coauthors, John Holahan, director of the Urban Institute Health Policy Center, and Allison Cook, an Urban Institute research assistant.

By contrast, only 11.3 percent of the country's 8 million uninsured children can not afford private coverage and have no public options available. "The strikingly different landscapes facing children and childless adults testify to how important the establishment of SCHIP and other coverage expansions have been for the welfare of the nation's children," Dubay said.

To reduce the number of uninsured people who are eligible for public programs, the Urban Institute authors state that "extensive outreach efforts and simplified enrollment and redetermination procedures, including easing requirements for documentation of income, assets, and citizenship," would be necessary. However, since most of the uninsured who cannot afford coverage are not covered by existing programs, the researchers say that much more will be needed. They suggest "sliding-scale subsidies or income-related tax credits," as well as health insurance market reforms, as steps that could make coverage more affordable for the uninsured.

Defining 'Affordability'

As a threshold to determine whether an uninsured person would be able to afford coverage without assistance, Dubay and coauthors used an income level of 300 percent of the federal poverty level (FPL); in 2004, 300 percent of the FPL amounted to $28,935 for a single person and $57,921 for a family of four. The researchers calculated that people at these income levels would pay 13.8 percent of their incomes for individual coverage and 17.2 percent of their incomes for family coverage. Because fewer than one in five uninsured workers were offered employer-sponsored coverage in 2005, the researchers assumed that most of the uninsured would be buying coverage in the private nongroup market, but they used small-group market premiums as a proxy in their calculations because reliable measures of nongroup premiums are unavailable.

"Because it is possible to define affordability in many different ways, we conducted a sensitivity analysis to see the effect of setting the affordability threshold at different levels," Dubay and her colleagues write. Specifically, the researchers looked at the effect of raising the affordability threshold to 400 percent of the FPL. They also examined the effect of deeming coverage unaffordable for any uninsured person who would have to pay more than 10 percent -- or, alternatively. 15 percent -- of his or her income in premiums. Finally, in recognition of the fact that premiums might be lowered by decreasing benefits or increasing deductibles, the researchers reduced premiums by 20 percent, then looked at the effects of deeming coverage unaffordable for anyone who would have to use more than 10 percent of his or her income to pay even these reduced premiums.

Affordability: A Problem Under Any Measure

"Regardless of the affordability threshold used, the bulk of uninsured parents and childless adults are not eligible for public coverage and likely not able to afford private coverage," the researchers state. In fact, using any of the four alternative thresholds described above increased the proportion of the uninsured population with no access to public assistance for whom coverage is unaffordable.

Moreover, the authors warn that the affordability problem is likely to be even greater than their research indicates. "We deemed coverage affordable for the 20 percent of the uninsured in families with incomes above 300 percent of the FPL," Holahan said. "However, a large share of the uninsured would have to purchase coverage in the nongroup market, an arena where poor health can mean substantial premiums or complete rejection. Therefore, for some of the uninsured in our 'affordable' group, chronic disease or other health problems may in fact put coverage out of reach."

The full article by Dubay and her coauthors can be read at Health Affairs. 

TrackBack URL for this entry: http://www.typepad.com/services/trackback/6a00d8341fd8ea53ef00d834cbc0c253ef

Join the dialogue here

Dec 4, 2006 11:58:31 PM
Monica M. Arce, RN SNM says

One more report that confirms not only that most uninsured are actually working one or more full-time jobs. Minimum wage jobs, or several part-time low-paying jobs, are not enough to be able to afford health care coverage. Too poor to be able to pay for it, to rich to be able to access federal/state help. One of the biggest symptoms of a broken health care system, in the richest country of the world. A shame.

Jan 5, 2007 5:17:32 PM
R. Carrillo says

In the past 30 years, the costs of healthcare have soared in the United States. Due to rapidly escalating healthcare costs, Americans in ever increasing numbers have begun to search for alternatives that could reduce their personal out-of-pocket medical expenses. In the last few years, hundreds of thousands of Americans have chosen to become Medical Tourists.

Cost of medical and surgical procedures in Mexico is very low compared to what is paid in the United States. In most cases, the savings from their medical treatment can give people extra money for vacation. Indeed, a patient and his/her family can take a luxury vacation in a Mexican resort and pay for the trip with the savings they receive on getting their procedures in Mexico. Medical Tourism in the city of Guadalajara can certainly be a win-win proposition. While taking care of health needs at big discounts, shopping sprees, sight-seeing, cultural pursuits, and trips to nearby beaches and spas can all be arranged around a medical appointment schedule.

For more information contact www.surgicalcareinternational.com

Apr 28, 2009 10:29:54 AM
Increase Penis Size says

More & more people know that blog are good for every one where we get lots of information any topics !!!

May 28, 2009 9:12:12 AM
teenagers learn to drive says

As noted in Directive 2008- 80: Voter Identification Requirements, in poll worker training courses, and in the Quick Reference Guide at every polling location, a voter presenting a valid Ohio driver’ s license or Ohio photo ID must be provided a regular ballot even if the address on the ID and the address in the poll book are not identical. In such case, a poll worker must record the last 4 digits of the voter’ s driver’ s license or Ohio ID card number in polling place records as instructed by the board of elections.

Jul 5, 2009 10:20:56 AM
AnneriaAppoca says

Read more hot reports about Business, Form business or Women small business loans http://business.goodnano-av.com/

Dec 19, 2011 10:32:07 AM
Online pharmacy reviews says

well the first step to solve this problem, is elimanate the source of the problem, the so bad policts that our leaders has chosen for us.

Dec 26, 2011 11:24:13 PM
kasdloe says

Thanks so much for your great page, this is the stuff that keeps me awake through out these day. I've been searching around for your site after being referred to them from a buddy and was thrilled when I was able to find it after searching for some time. Being a demanding blogger, I'm glad to see others taking initivative and contributing to the community. I would like to comment to show my appreciation for your post as it is very challenging to do, and many bloggers do not get appreciation they deserve. I am sure I'll drop by again and will send some of my friends.
ipad apps To use it you must first download and
www.kazaa.com/kazaa.com The instructions to download it and install it are below.www.napster.com/

The comments to this entry are closed.



Subscribe to this Rx for Health Care feed.