Many Insured U.S. Residents Forgo Care Because of Cost, Witnesses Say at HELP Committee Hearing

Many U.S. residents with health insurance delay or forgo needed medical care because of cost, according to witnesses at a Senate Health, Education, Labor and Pensions Committee hearing on Tuesday examining the problem of underinsurance, CQ HealthBeat reports. Sen. Jeff Bingaman (D-N.M.), who chaired the meeting, said underinsurance is defined as "an insured individual whose family medical expenditures total 10% or more of their income or whose health plan includes deductibles greater than 5% of their income."

Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured, said, "When people have cost concerns, they delay care even when it's really important to get it," adding, "High levels of cost-sharing and caps on covered benefits can compromise the level of protection health insurance provides and lead to both reduced access to needed care and serious financial burdens and medical debt." Rowland added that about three in 10 non-elderly adults with health insurance in October 2008 reported problems paying medical bills.

Cathy Schoen, senior vice president of the Commonwealth Fund, said the number of underinsured U.S. adults increased by 60% between 2003 and 2007. She estimates that 25 million U.S. adults younger than age 65 were underinsured in 2007, of whom more than 50% went without recommended treatment, medication, follow-up care or physician visits. Schoen said, "It's getting harder to tell the underinsured and the uninsured from each other."

Gail Shearer, director of health policy analysis at Consumers Union, said, "The underlying problem is that health care costs are high." Shearer recommended that Congress increase comparative effectiveness research, which could lower costs by providing better knowledge for treatment and coverage decisions. She added that in order to provide affordable health care coverage, policymakers should set income-related premiums, establish a minimum base and norm for health insurance, and place limits on out-of-pocket expenses for low-income families. Grace-Marie Turner, president of the Galen Institute, recommended that employers offer flexible benefit options and health savings accounts (Attias, CQ HealthBeat, 2/25).

Rowland's testimony is available online.