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TUESDAY, March 25, 2014 (HealthDay News) -- Nearly 32 million Americans had inferior health insurance coverage in 2012, putting them at risk of skimping on needed health care or piling up medical debt, a new report finds.
Another 47 million had no insurance at all, according to the Commonwealth Fund report released Tuesday.
People who are underinsured are likely to have experiences like the uninsured, said Dr. David Blumenthal, Commonwealth Fund president, at a Monday teleconference.
"They are, for example, more likely to skip needed health care," he said.
Most of the underinsured are low- or middle-income people -- the population that the new U.S. health reform law was designed to help, fund officials said. They said their findings indicate the legislation is well-targeted.
The report is believed to provide the first state-by-state analysis of the nation's "underinsurance" problem. It found a low of 8 percent underinsured in New Hampshire and highs of 16 percent to 17 percent in Tennessee, Mississippi, Utah and Idaho.
However, the report also highlights a glaring gap in coverage that could persist despite the expansion of coverage under the health reform law. More than 15 million uninsured and underinsured Americans are poor, earning less than the federal poverty level, and living in states that have not expanded Medicaid.
"Unless these states join the expansion, there will be no new affordable options available to this population," cautioned Cathy Schoen, the fund's senior vice president and lead author of the report, at the teleconference.
The Commonwealth Fund is a private foundation that supports independent health care research.
Congress passed the Affordable Care Act, also called Obamacare, in 2010, ushering in new consumer protections and health insurance options. The rollout of private health plan options through state marketplaces and the expansion of Medicaid took effect this year.
Twenty-four states decided not to expand Medicaid in 2014. In states like Idaho, which has the nation's highest percentage of underinsured individuals -- 17 percent, the Affordable Care Act has been a boon and a bust.
Some Idahoans are benefiting from the subsidies available to help people purchase better coverage, but people who fall below the poverty line have no coverage options because the state did not expand Medicaid.
"It left a big hole," said Terri Sterling, a director at the Idaho Community Action Network, a Boise-based organization helping to empower low-income and working Idahoans.
By the Commonwealth Fund's definition, people are underinsured if they have coverage but spend 10 percent or more of their income, or their family income, on out-of-pocket medical care, excluding the premium.
People with very low incomes, below 200 percent of the federal poverty level, are considered underinsured if they spend 5 percent or more of their income on medical care.
In all, 79 million people were uninsured or had inadequate coverage in 2012, prior to the expansion of new health insurance options under the Affordable Care Act, the report found.
Nationally, nearly one in three people (29 percent) was uninsured or underinsured. Massachusetts had the lowest rate of people lacking sufficient coverage or any coverage at all -- 14 percent. The highest rates, at 38 percent, were in Nevada, New Mexico and Texas, followed by Idaho and Florida, at 36 percent.
Four million people, or 13 percent of the total underinsured population, were middle-income, earning between $47,000 and $95,000 for a family of four.
Four out of five underinsured people -- 26 million people in all -- were low-income, earning less than 200 percent of the federal poverty level, or below $47,000 a year for a family of four.
Some good news was noted, too. The number of people lacking any insurance dropped by 2 million to 47 million people in 2010. That improvement is probably the result of a provision of the Affordable Care Act allowing young adults to stay on their parents' health insurance plan, the authors said.
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SOURCES: March 24, 2014, teleconference with David Blumenthal, M.D., president, and Cathy Schoen, senior vice president, Commonwealth Fund, New York City; Terri Sterling, director, Idaho Community Action Network, Boise; March 25, 2014, report, Commonwealth Fund, America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions