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People Without Jobs and Insurance Skip Medicine, Health Care

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A report from the Commonwealth Fund in New York says the vast majority of people who lost both their jobs and health insurance in the past two years skipped needed health care or did not fill prescriptions because of the cost. The data for the study come from the Commonwealth Fund’s 2010 Biennial Health Insurance Survey, conducted July to November 2010, and reporting on 3,033 respondents in the U.S. age 19 to 64.

The report suggests that the link between employment and health insurance dictates much of the health care activity in which Americans engage.  Some six in 10 working Americans rely on health insurance obtained through their employer, and when an estimated 15 million working-age adults lost their jobs and their employer-based insurance between 2008 and 2010, 9 million Americans were added to the rolls of the uninsured.

In 2010, more than half (57%) of those who said they had lost their job with health benefits in the past two years became uninsured because they had few options for affordable health insurance that met their needs. One of those options is the Consolidated Omnibus Budget Reconciliation Act (COBRA), which allows unemployed workers to keep their health insurance for up to 18 months, but requires paying the full cost of the premiums.

Another option, the individual policy market, is also out of reach for most unemployed workers. The report finds that six in 10 (60%) of people who shopped for individual insurance policies over the last three years were unable to find a plan they could afford, and about a third (35%) were turned down by an insurer, charged more because of their health status, or had a specific health problem excluded from their coverage.

As a result, the lack of both a job and insurance can markedly affect a person’s health-related practices and financial security. The report indicates that more than seven in 10 (72%) of respondents who became uninsured said they did not fill a prescription, or skipped a recommended test, treatment, or follow-up. These skipped activities include not visiting a doctor or clinic when faced with a medical problem, or declining specialist care because of cost.

The same percentage — 72 percent — of those who lacked both a job and insurance reported problems with medical bills, including not being able to pay their bills, paying off medical debt over time, being contacted by a collections agency over unpaid bills, or changing their way of life to pay medical bills.

Some four in 10 (40%) of those lacking both a job and insurance said they were forced into making difficult financial tradeoffs in the past year because of medical bills. One-third (32%) said they used up all their savings, while about a quarter (27%) could not pay for basic necessities like food, heat or rent. Smaller percentages took on credit card debt (14%) or took out a home mortgage or loan (9%).

The Commonwealth Fund points out that parts of the Affordable Care Act that went into effect last year, such as extending family coverage to single adults up to age 26 and creation of pre-existing condition insurance plans will alleviate some of the problems encountered by the unemployed and uninsured. The most significant impact will take place in 2014, says the report, when the combination of Medicaid expansion and subsidized rates under the new state insurance exchanges makes health insurance available to a much larger number.

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