Underinsured rate climbing among American adults

Health insurance, pen and stethoscope
The rate of underinsured individuals has climbed since 2014, when it was 23% of U.S. adults, or 31 million people. (Getty/Minerva Studio)

Despite all the progress that the Affordable Care Act has made in reducing the number of uninsured individuals, new research says a significant share of U.S. adults are still underinsured.

An estimated 41 million people—or 28% of U.S. adults ages 19 to 64—who were insured all year as of late 2016 were also underinsured, according to an analysis from The Commonwealth Fund.

Per the analysis, people are defined as “underinsured” if: 

  • Their out-of-pocket costs, excluding premiums, over the prior 12 months are equal to 10% or more of household income; or
  • Their out-of-pocket costs, excluding premiums, over the prior 12 months are equal to 5% or more of household income if income is under 200% of the federal poverty level; or
  • Their deductible is 5% or more of household income.

The rate of underinsured individuals has climbed since 2014, when it was 23% of U.S. adults, or 31 million people. In addition, it has more than doubled since 2003.

Among those individuals who were privately insured, rates of being uninsured were highest among people with individual market coverage, the analysis pointed out. The trend was not confined just to those people, however; as rates climbed across most coverage sources. For example, 26% of adults with Medicaid coverage were underinsured in 2016.

One of the biggest factors driving up the underinsured rate is the rise of high deductibles, the analysis noted. Over the past 13 years, the share of privately insured adults who had health plans without deductibles has fallen by nearly half, while deductible sizes have grown. Thirteen percent of adults enrolled in a private plan in 2016 had a deductible of $3,000 or more, compared to just 1% in 2003.

One recent study found that high-deductible health plans reduce enrollees’ use of healthcare services, including necessary and preventive care. This is also borne out by The Commonwealth Fund’s research, as it found that more than 45% of underinsured adults reported not getting needed care because of cost in the past year—including not going to the doctor when sick, not filling a prescription, skipping a test or treatment recommended by a doctor or not seeing a specialist.