Hospital Business Week (pg. 144), August 26, 2007

INSURED BUT NOT ADEQUATELY COVERED

Consumer Reports Health Insurance Survey Reveals 1 in 4 People Insured but Not Adequately Covered

A new Consumer Reports study identifies the "underinsured" -- accounting for 24% of the U.S. population -- living with skeletal health insurance that barely covers their medical needs and leaves them unprepared to pay for major medical expenses.

Forty-nine percent of people overall, and 43 percent of people with insurance said they were "somewhat" to "completely" unprepared to cope with a costly medical emergency over the coming year. Some 16 percent of the people surveyed had no health plan at all, including many working respondents whose jobs didn't offer insurance or who couldn't afford the premiums of deductibles of the available plan.

When added to the population of "uninsured" -- approximately 16% of the population -- a total of 40% of Americans ages 18-64 have, at best, inadequate access to health care. The report, published in the September issue, also finds that most employers are struggling to keep up while the insurance behemoths prosper from the misery.

In the first of a series of reports on America's health care crisis, Consumer Reports paints a profile of the "underinsured," explains what it means to be insured but not adequately covered, and tells of the costs and consequences for everyone, including people who are currently "well insured." The report is based on a survey conducted by the Consumer Reports National Research Center in May 2007, which sampled 2,905 Americans between ages 18 and 64. The survey found evidence of increasing frailty in the U.S. system of health insurance on almost all fronts.

The September issue of Consumer Reports also includes ratings of the best HMOs and PPOs, based on the experiences of 37,000 readers.

Defining "Underinsured": Insured But Not Covered

People falling into the "underinsured" category have two or more of the following complaints about their health plans: It does not adequately cover costs of prescription drugs; doctor visits; medical tests; surgery or other medical procedures; catastrophic medical conditions; or the deductible is too high.

CR notes that the new emerging class of "underinsured" could be you or your neighbor. In the CR survey, the median household income of respondents who were "underinsured" was $58,950, well above the U.S. median. Twenty-two percent live in households making more than $100,000. Still, many of the "underinsured" don't have the resources to keep up with the rising costs of deductibles and co-pays, so much so that 43% reported that they postponed going to the doctor because they couldn't afford it.

Twenty-eight percent told Consumer Reports they put off filling prescriptions. In addition to digging deep into their savings, raiding their retirement accounts and running up credit card balances, 27% of the "underinsured" said they were still in debt to doctors and hospitals. Three percent said medical bills had forced them to declare bankruptcy.

This article was prepared by Hospital Business Week editors from staff and other reports.

Copyright 2007, Hospital Business Week