Are the uninsured in America who we think they are?
| Jan 24, 2014
January 1 was not only the start of the new year; it also was the first day that brought healthcare coverage to the previously uninsured who signed up for coverage under the Affordable Care Act (ACA). The ACA’s critics fear the uninsured are less healthy than insured Americans, meaning premiums and healthcare costs would be higher for everyone. But is this really true? Can uninsured Americans be segmented into categories that will help us understand who might enroll?
By examining the U.S. uninsured population based on our proprietary patient research of 50,000 adults, we were able to characterize the uninsured populations and to determine if characteristics or behaviors could be indicative of those who are likely to sign up.
Perhaps surprisingly, our analysis showed that the uninsured are generally physically healthier than those with insurance. As a whole, the uninsured are more likely to be younger, male, non-white, unmarried and have a larger household size. However, the uninsured group is not homogeneous and can be segmented into three demographic subpopulations:
- Young families
- Adult families
The largest subpopulation of uninsured is the adult family group, which consists of two or more adults with no children in the household. Employer-sponsored insurance is the main avenue for obtaining private insurance, and so not surprisingly employment status is the biggest direct contributor to health insurance status. The uninsured are disproportionately employed part-time, self-employed or unemployed, placing them heretofore at a disadvantage for obtaining insurance. The circumstances of employment also contributes to their low income levels, which places many among the “working poor,” making cost a critical issue and possibly a deterrent to enrolling in insurance options now available.
Uninsured Americans have both lower education levels and lower incomes than those with insurance. Thirty-six percent of the uninsured have a high school education or less (vs. 23 percent of the insured), which not only affects earning potential, but may also be a barrier to understanding insurance options. Indeed, 40 percent of the uninsured earning less than $25,000 per year (vs. 18 percent of the insured); moving the bar for Medicaid will make many more eligible, but significant subsidies are still needed to enable purchase of insurance for many.
Another barrier to enrollment is the general health of uninsured Americans compared with those with insurance. Uninsured Americans have a significantly lower rate of comorbidities than those with insurance. In fact, the uninsured are more likely to have no comorbidities (84 percent vs. 74 percent), which means they have no significant diseases. If these patients are experiencing no major health problems, they are less likely to see the need to secure insurance.
For more insights into the uninsured populations in the United States, check out our infographic: Who are the Uninsured in America? My next blog will focus on the health status and attitudes of the uninsured population and how they may impact the insurance options now available with the passage of the ACA.