Underinsured in America

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A new study in Health Affairs takes up an issue often neglected in debates over health care, but quite important: namely, the underinsured. These people have coverage, but it’s usually inadequate, leaving them vulnerable to high out-of-pocket costs and often forcing them to forego essential care. About 12 percent of adults, some 16 million, fell into this category in 2003, which can be tacked onto the estimated 45 million without insurance at all. Most of the underinsured were either minorities, had low incomes, or were sick.

The other big story here is that the vast numbers of underinsured are the result of an increasing trend in America. Employers, wracked with health care costs, are responding by pushing more and more of the financial burden for coverage onto the workers themselves, whether that includes higher deductibles, patient cost sharing, or restricting benefits. As a result, many workers are left without adequate coverage, and end up seeking out less care in the end. (Cost-sharing, almost by definition, hits the poor and the sick the hardest.)

It’s doubtful that this trend can be reversed, and at any rate, it probably shouldn’t be. Employers were never meant to be in the business of providing health care, and that goes double in an age where workers switch jobs frequently and firms need to be competitive in the global economy. Eventually, the government will have to take over the business of managing care. That’s inevitable. The problem is that unless the transition period is well-managed—which is certainly not the case right now—then we’re in for a long period of time where companies are slowly and steadily loading the costs onto the backs of their workers and more and more employees become unable to afford adequate care. Eventually it will all hit a crisis point and voters will demand some sort of national health care system. But who knows when that will be? The interim period, meanwhile, will be devastating.

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We just wrapped up a shorter-than-normal, urgent-as-ever fundraising drive and we came up about $45,000 short of our $300,000 goal.

That means we're going to have upwards of $350,000, maybe more, to raise in online donations between now and June 30, when our fiscal year ends and we have to get to break-even. And even though there's zero cushion to miss the mark, we won't be all that in your face about our fundraising again until June.

So we urgently need this specific ask, what you're reading right now, to start bringing in more donations than it ever has. The reality, for these next few months and next few years, is that we have to start finding ways to grow our online supporter base in a big way—and we're optimistic we can keep making real headway by being real with you about this.

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