Enhanced coverage plugs holes in 'underinsured' care

There are many problems with the nation's healthcare system today, but I think there's one in particular that needs to be addressed--nearly half of all U.S. adults (81 million people!) were either "underinsured" or uninsured in 2010. For the underinsured, that means that despite paying for health insurance coverage all year, they still have very high medical expenses relative to their incomes.

And the numbers are increasing; the underinsured/uninsured adults totaled 61 million in 2003 and 75 million in 2007, according to a new Commonwealth Fund study published in the September issue of Health Affairs.

"Underinsured families are at nearly as high risk as the uninsured because, while they have health insurance, holes or limits in their plans expose them to often unaffordable medical costs," said lead study author and Commonwealth Fund Senior Vice President Cathy Schoen.

There must be a way to fix this problem and, although it's an issue with many layers and complexities, I believe health payers could lead the charge. It's in payers' best interest to properly insure their customers; otherwise, the underinsured delay healthcare, which puts an additional strain on the health system and increases costs for insurers. For example, the study found that the 46 percent of underinsured didn't fill a prescription, see a doctor when sick, or went without a recommended medical test or treatment, which likely leads to a sicker--and more expensive--member population.

Underinsured adults are more likely to delay or forgo care altogether because they're more likely to have limits on visits or caps on the dollar amount their insurance plan covers. The underinsured were also significantly more likely to report per person deductibles of $1,000 or more despite lower incomes. In fact, 33 percent of the underinsured, compared to only 12 percent of fully insured adults, reported a deductible of $1,000 or more. A family of four would have to spend $4,000 on deductibles before they would receive any insurance benefits. That's a lot of money, especially given the current economy.

Along those same lines, the study found that the underinsured often incur premium expenses that are high relative to their incomes. Roughly 31 percent of underinsured adults spent 5 percent or more of their annual income on premiums, and 19 percent spent 10 percent or more of their annual income. That's just unsustainable.

To reduce the number of underinsured, the study recommends that health payers keep deductibles and out-of-pocket costs low for essential, effective healthcare. In other words, insurers should offer well-designed plans with a value-based approach. Fortunately for the underinsured, this payment model is slowly gaining traction throughout the insurance industry. I can only hope that insurers choose to focus on this population and adjust their plans to help protect their health. This could be a huge opportunity for insurance companies to take small steps for the greater good of the community. - Dina (@HealthPayer)