More Than One-Fourth of Uninsured Adults with Chronic Conditions Do Not Receive ‘Needed’ Medical Care, Study Finds

More than 25% of uninsured adults between the ages of 18 and 64 with chronic conditions such as diabetes, heart disease and depression reported that they had not obtained "needed" medical care at least once in the previous year, compared with less than 10% of the privately insured with chronic conditions, according to a study released Feb. 20 by the Center for Studying Health System Change. According to the study, based on the HSC 1998-1999 Community Tracking Study Household Survey, about 7.4 million individuals with chronic conditions did not have health insurance in 1999. The study found that more than half of the uninsured with chronic conditions delayed care in the past year, with cost as the "major barrier to care." About 63% had annual family incomes less than 200% of the federal poverty level, about $35,000 for a family of four, compared with 18% of those with private health insurance. In addition, 40% of uninsured adults ages 18 to 64 with chronic conditions reported "fair or poor health," compared with less than 20% of those with private health insurance (Reed/Tu, "Triple Jeopardy: Low Income, Chronically Ill and Uninsured in America," February 2002). Although all individuals with chronic conditions face a higher risk for serious disability without "good access to ongoing care," HSC health research analyst Marie Reed, a co-author of the study, said that "it is clear that the uninsured with chronic conditions generally receive significantly less medical care than insured people." The study, titled "Triple Jeopardy: Low Income, Chronically Ill and Uninsured in America," is available online.

Policy Implications
According to a second study released Feb. 20 by HSC, most plans proposed by policy makers to help the uninsured would only "reach a limited number" of those who have chronic conditions (HSC release, 2/20). The study found that individuals with chronic conditions require "more costly and intensive" health services "in excess of standard insurance risk," which "causes conventional concepts of insurance and risk to break down." As a result, health insurance programs targeted at individuals with chronic conditions "would be costly," and policy makers would face "considerable challenges determining which conditions -- and what level of severity -- should trigger eligibility" (Tu/Reed, "Options for Expanding Health Insurance for People with Chronic Conditions," February 2002). The study also found:

• Individuals with chronic conditions often cannot find affordable coverage in the individual insurance market "unless subsidies are adjusted to reflect their higher expected medical costs."
• Subsidies targeted at employees to help them cover the cost of health insurance premiums would reach few of the uninsured with chronic conditions "because less than one in five has access to employer-sponsored insurance."
• Subsidies targeted at employers with fewer than 50 employees would only reach 40% of the uninsured with chronic conditions "because they either work or have a family member working for a small firm not offering insurance."
• An expansion of CHIP to cover parents of eligible children would reach about one-third of the uninsured with chronic conditions.
• A plan to eliminate Medicaid eligibility requirements except low income -- 200% of the federal poverty level -- would extend coverage to about two-thirds of the uninsured with chronic conditions but would "carry a high price tag."