In the midst of the best economy in 30 years, health care costs remain a significant financial burden for many low- and middle-income families. A large proportion of Americans earning under the median family income of $35,000 are uninsured, go without needed care, face collection agencies when they cannot pay their medical bills, and report poor health, according to Can't Afford to Get Sick: A Reality for Millions of Working Americans, a new report based on The Commonwealth Fund 1999 National Survey of Workers' Health Insurance. Authors John Budetti, Lisa Duchon, Cathy Schoen, and Janet Shikles find that a surprising number of middle- and higher-income Americans also have difficulties getting needed medical care and paying medical bills. The report is based on findings from the Fund's survey of 5,002 Americans ages 18 to 64, which was conducted from January through May 1999 by Princeton Survey Research Associates.
Many Working Americans Are Shut Out of the Health Care System
Lack of insurance remains a significant and growing problem, especially for those living in the bottom half of the income distribution. While nearly one of five (19%) working-age adults lacked health insurance, almost one of three (32%) adults with incomes below $35,000 were uninsured. Two of five (41%) adults with incomes in the bottom fourth (earning less than $20,000 annually) lacked health insurance. In contrast, just 7 percent of working-age adults with incomes $35,000 and above were uninsured.
Many working Americans with below-average incomes do not have the option of obtaining coverage from their jobs, a problem that is particularly acute for low-wage workers. Two of five (42%) workers with incomes less than $20,000 either were not offered a plan through their workplace (25%) or were not eligible to participate in an employer-sponsored plan (17%).
Uninsured workers rarely had the option of employer-based coverage. Only 16 percent of those working but uninsured were eligible for an employer plan, and many worked for employers who did not offer health benefits.
Hispanics were generally at high risk of being uninsured and lacking access to employer plans. Nearly two of five Hispanics were uninsured. Among those who were working, one of three (34%) did not have a health plan available through their job, compared with 18 percent of whites and 17 percent of blacks.
"We have to recognize that our system of providing health insurance often does not work well for millions of working Americans," said Karen Davis, president of The Commonwealth Fund. "As we look forward to the 21st century, we need to look for solutions that could enhance opportunities for working men and women to lead healthy, productive lives."
Health Care Financial Burdens Affect Health and Economic Security
High health care costs have consequences for people of all incomes. One of four (24%) adults—an estimated 40 million working-age Americans—either did not fill a prescription, failed to get a recommended test or treatment, or failed to see a doctor when needed because they could not afford it. More than one of three living below the median U.S. income, and nearly half (45%) of those in the bottom fourth of the income range, went without needed medical care in the previous year.
Economic security, already tenuous for many Americans, is further threatened by health care costs. One of three (33 percent) working-age adults, representing 54 million Americans, described their financial situation as having "just enough" or "not enough" money to meet basic living expenses. Medical bills add a significant economic burden: more than half (51%) of those with incomes less than $20,000 and three of 10 (30%) adults with incomes between $20,000 and $35,000 did not have enough money to pay their medical bills in the past year. An estimated 31 million people—or nearly one of five (19%) working-age adults—were contacted by a collection agency for unpaid medical bills in the past year, including one of three (34%) of those with incomes less than $20,000.
A surprising number of people with higher incomes faced medical bill problems as well. One of four with incomes between $20,000 and $35,000 were contacted by collection agencies for unpaid medical bills, as were 14 percent of those with incomes between $35,000 and $60,000.
Task Force Formed to Search for Innovative Solutions
To address these and other issues, The Commonwealth Fund has created the Task Force on the Future of Health Insurance for Working Americans. The nonpartisan expert panel will comprise individuals nationally recognized for their contributions in the fields of business, government, public policy, economics, and medicine. "The Task Force will work to put the debate over expanding health insurance coverage back on the national policy agenda," said chair James J. Mongan, M.D., president and CEO of Massachusetts General Hospital. "We hope to support work that will enable the nation to make progress toward reducing the number of uninsured Americans and improving the stability and quality of health insurance for working families."
The Task Force will carry out and support cutting-edge research to redesign coverage to fit a 21st century labor force. Its initial project will be to develop workable solutions to the problem of working Americans who lack health insurance, and to provide constructive analyses on a wide range of options that have the potential for broad-based support.
