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Being Uninsured: By Choice or Circumstance?

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Being Uninsured: By Choice or Circumstance?

Colleen McGuire

Updated: March 14, 2019    Published: December 4, 2015

Between 2000-2010 the number of uninsured rose as the recession left individuals unemployed or choosing not to spend money on healthcare as they tightened their purse strings. With the implementation of the Affordable Care Act and launch of state exchanges and the federal marketplace, millions of uninsured individuals signed up for subsidized health insurance, and starting using their coverage. The boon of card-carrying insureds has decreased the number of uninsured by 9 million, and escalated healthcare spending past the 3 trillion mark. Despite arguments that Obamacare is a bad piece of legislation, Americans are participating in the healthcare system more than in recent memory.

But what about the remaining 32 million uninsured?

A 2015 study by the Robert Wood Johnson Foundation took a closer look at the uninsured population to determine how they were living and access healthcare without health insurance. The statistics were telling:

  • 43% have looked into buying health insurance
  • More than half of the uninsured have dealt with major change (job loss, moving, death in the family) and only 25% say they are doing okay financially
  • 58% have less than $100 after paying bills and have little savings
  • 43% of uninsured are employed
  • 41% have had three different jobs in 5 years
  • A majority of uninsured are hourly workers for small employers
  • 55% work in construction, retail, food service, manufacturing, healthcare
  • Since they are struggling financially, they get healthcare using free and low cost clinics
  • 31% have a medical condition

The reason those surveyed remain uninsured is clear – cost trumps all for those living paycheck to paycheck. A Kaiser Family Foundation found similar results. Costs are a major barrier for low income workers. The unfortunate result is less access to care for the uninsured. Health providers can deny individuals without health insurance coverage. The uninsured are also more likely to avoid preventive care, and are more likely to skimp on prescription drugs or other medical treatments they need.

It is no surprise medical bankruptcy is higher for those who are uninsured. Thirty-two percent of the uninsured carry some sort of medical debt, and medical bankruptcy still attributes to more than 50% of all debt filed.

What can the uninsured do to get covered? The first step is to make sure every stone has been overturned to get coverage.

See if Subsidy Dollars Are Available

A study by eHealth on the first month of shopping during the 2015 open enrollment period revealed that 28% of those shopping online were doing so because they had learned that they could qualify for coverage under the Affordable Care Act. Robert Wood Johnson’s study of the uninsured found that 59% of the uninsured didn’t realize they could qualify for a subsidy to reduce the cost of health insurance. When running a quote for a health insurance plan, use a website that can demonstrate how much subsidy dollars will contribute to the overall cost of coverage.

Check on State Expanded Medicaid

When the Affordable Care Act initially launched in the marketplace, some states decided to expand Medicaid, allowing more lower income workers into the pool. But not all states jumped on board at the same time. Each year more states have relaxed their Medicaid income guidelines, and to date, 30 states have expanded Medicaid. It’s good to check back each year during the open enrollment period to see if a state legislature has paved the way for low income residents.

Short Term Health Insurance Alternative

For individuals and families that cannot afford a major medical policy or choose not to, there are alternatives. Short term health insurance can provide coverage to help avoid catastrophic medical debt. There are no networks or restrictions on doctors, and plans can generally run between $50- $90 each month depending on age, gender and state of residence. Some plans include copay options for seeing a doctor, or offer prescription drug coverage.

The number of uninsured in the United States is decreasing, but there is still a long way to go. Until then, make sure every avenue is investigated to get medical insurance coverage.

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The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and

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