Figure 1. Increases in Health Insurance Premiums
Compared with Other Indicators, 1988–2005
Percent
Health insurance premiums
20
Workers earnings
Overall inflation
18.0
15
^
13.9
12.9* 11.2*
10.9*
12.0
10
8.5
5.3*
5
Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 2005.
* Estimate is statistically different from the previous year shown at p<0.05.
^ Estimate is statistically different from the previous year shown at p<0.1.
Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Historical
estimates of workers’ earnings have been updated to reflect new industry classifications (NAICS).
05
20
04
20
03
20
02
20
01
20
00
20
99
19
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
19
89
19
88
98
0.8
0
19
9.2*
8.2*
THE
COMMONWEALTH
FUND
Figure 2. Deductibles Rise Sharply,
Especially in Small Firms, Over 2000–2005*
PPO in-network and out-of-network deductibles
$900
2000
$750
676
$600
510
469
383
$450
$300
2005
254
210
319
157
$150
$0
In-network
Out-of-network
Small firms
(3–199 employees)
In-network
Out-of-network
Large firms
(200+ employees)
* Out-of-network deductibles are for 2000 and 2004.
Source: J. Gabel and J. Pickreign, Risky Business: When Mom and Pop Buy
Health Insurance for Their Employees (Commonwealth Fund, Apr. 2004);
KFF/HRET Employer Health Benefits 2005 Annual Survey.
THE
COMMONWEALTH
FUND
Figure 3. Percent of Firms Offering Health Benefits
Declined Over 2000–2005
Percent of firms offering health benefits
75
69
68
66
66
63
2002
2003
2004
60
50
25
0
2000
2001
2005
THE
COMMONWEALTH
FUND
Source: KFF/HRET Employer Health Benefits 2005 Annual Survey.
Figure 4. 47 Million Uninsured in 2005;
Increasing Steadily Since 2000
Number of uninsured, in millions
56
60
40
33
31 33
35 35
41
39 40 40
42
43 44
40 40 41
44 45
46 47
20
0
1987
1990
1993
1996
1999*
2002
2005
*1999–2003 estimates reflect the results of follow-up verification questions
and implementation of Census 2000-based population controls.
Note: Projected estimates for 2006–2013 are for nonelderly uninsured based on
T. Gilmer and R. Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured
Through 2013,” Health Affairs Web Exclusive, Apr. 5, 2005.
Source: U.S. Census Bureau, March CPS Surveys 1988 to 2005.
2008
2011 2013
Projected
THE
COMMONWEALTH
FUND
Figure 5. Americans Spend More Out-of-Pocket
on Health Care Expenses
National health expenditures per capita (US$)
6000
United States
5000
4000
3000
Netherlands
2000
1000
Germany Canada
Australia
France
OECD Median
Japana
New
Zealand
0
0
100
200
300
400
500
600
700
800
900
Out-of-pocket health care spending per capita (US$)
a
2002
Note: Adjusted for differences in the cost of living, 2003.
Source: B.K. Frogner and G.F. Anderson, Multinational Comparisons of Health Systems Data, 2005,
The Commonwealth Fund, April 2006.
THE
COMMONWEALTH
FUND
Figure 6. Americans Are Spending More
Out-of-Pocket for Health Care
Dollars spent per capita (in 2004 dollars)
900
$788
$774
800
700
600
500
400
$667
$577
$583
300
200
100
19
7
19 0
7
19 1
7
19 2
7
19 3
7
19 4
7
19 5
7
19 6
7
19 7
7
19 8
7
19 9
8
19 0
8
19 1
8
19 2
8
19 3
8
19 4
8
19 5
8
19 6
8
19 7
8
19 8
8
19 9
9
19 0
9
19 1
9
19 2
9
19 3
9
19 4
9
19 5
9
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
04
0
Source: C. Smith et al., “National Health Spending in 2004: Recent Slowdown Led
by Prescription Drug Spending,” Health Affairs 25, no. 1 (Jan./Feb. 2006); Centers
for Medicare and Medicaid Services, National Health Expenditures Data;
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
THE
COMMONWEALTH
FUND
Figure 7. Adults with Individual Coverage
Are More Likely to Spend $5,000 or More Annually
on Personal Out-of-Pocket Expenses
Percent of adults ages 19–64 insured all year with private insurance
Annual out-of-pocket costs $5,000 or more
75
Annual out-of-pocket costs $1,000–$4,999
50
25
41
31
30
4
3
27
27
Total
ESI
8
33
0
Individual
THE
ESI = employer-sponsored insurance.
COMMONWEALTH
FUND
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
Figure 8. Adults with Higher Deductibles
Are More Likely to Spend $1,000 or More
on Personal Out-of-Pocket Expenses
Percent of adults ages 19–64 insured all year with private insurance
Annual out-of-pocket costs $5,000 or more
100
Annual out-of-pocket costs $1,000–$4,999
75
50
25
55
31
4
40
27
2
27
25
Total
<$500
13
5
35
42
0
$500–$999
$1,000+
Annual deductible
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
THE
COMMONWEALTH
FUND
Figure 9. One-Quarter of Adults Spent 10 Percent
or More of Their Household Income Annually on
Family Out-of-Pocket Expenses and Premiums
Percent of adults ages 19–64 insured all year with private insurance
100
Spent 5% or more of income on out-of-pocket costs
Spent 10% or more of income on out-of-pocket costs
75
50
65
40
43
38
25
25
24
0
Total
ESI
Individual
THE
ESI = employer-sponsored insurance.
COMMONWEALTH
FUND
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
Figure 10. Adults with Higher Deductibles Are More
Likely to Spend a Greater Share of Household Income
on Family Out-of-Pocket Expenses and Premiums
Percent of adults ages 19–64 insured all year with private insurance
100
Spent 5% or more of income on out-of-pocket costs
Spent 10% or more of income on out-of-pocket costs
67
75
55
50
25
40
36
25
36
43
22
0
Total
<$500
$500–$999
$1,000+
Annual deductible
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
THE
COMMONWEALTH
FUND
Figure 11. Low-Income Households at Most Risk
for Spending Greater Shares of Income on
Family Out-of-Pocket Expenses and Premiums
Percent of adults ages 19–64 insured all year with private insurance
Spent 5% or more of income on out-of-pocket costs
Spent 10% or more of income on out-of-pocket costs
75
61
57
50
25
42
40
40
37
25
30
21
18
0
Total
<$20,000
$20,000–
$39,999
$40,000–
$59,999
$60,000+
Annual income
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
THE
COMMONWEALTH
FUND
Figure 12. Adults with High Deductibles
Are More Likely to Avoid Needed Health Care
Because of Cost
Percent of adults ages 19–64 insured all year with private insurance
75
<$500
$500–$999
$1,000+
44
50
25
16
22
27
8
12
19
11
17
26
12
19
24
25
31
0
Did not fill a
Did not see
Skipped
Had medical
Any of the four
prescription
specialist when
recommended
problem, did not
access
needed
test, treatment,
see doctor or
problems
or follow-up
clinic
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
THE
COMMONWEALTH
FUND
Figure 13. Cost-Sharing Reduces Use of Both
Essential and Less Essential Drugs and
Increases Risk of Adverse Events
Percent reduction in drugs per day
Elderly
Low Income
22
25
10
Elderly
140
120
20
15
Percent increase in incidence per 10,000
14
15
100
Low Income
117
97
78
80
9
43
60
40
5
20
0
0
Essential
Less Essential
Adverse Events
Source: R. Tamblyn et al., “Adverse Events Associated with Prescription Drug Cost-Sharing
Among Poor and Elderly Persons,” JAMA, Jan. 24/31, 2001 285(4):421–29.
ED Visits
THE
COMMONWEALTH
FUND
Figure 14. Adults with High Deductibles
Have Problems Paying Medical Bills
or Are Paying Off Medical Debt
Percent of adults ages 19–64 insured all year with private insurance
75
<$500
$500–$999
$1,000+
50
25
14
27
23 20
8
9
5
6
13
17
31
17
35
41
23
0
Not able to pay
Contacted by
Had to change
Medical bills/
Any medical bill
medical bills
collection
way of life to
debt being paid
problem or
agency*
pay medical
off over time
outstanding
bills
debt
* Includes only those individuals who had a bill sent
THE
to a collection agency when they were unable to pay it.
COMMONWEALTH
FUND
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
Figure 15. Increased Health Care Costs Have
Reduced Savings
Has increased spending on health care expenses in the past year caused you to do
any of the following? Among those with health insurance coverage who had
increases in health care costs in the last year (n=731) (percentage saying yes)
Decrease your contributions to
other savings
45%
34%
Have difficulty paying for other bills
Use up all or most of your savings
29%
Decrease your contributions to a
retirement plan, such as a 401(k),
403(b) or 457 plan, or an IRA
26%
Have difficulty paying for basic
necessities, like food, heat, and housing
Borrow money
24%
18%
THE
COMMONWEALTH
FUND
Source: EBRI Health Confidence Survey, 2005.
Figure 16. Few Insured People Are Currently
Covered by High-Deductible Health Plans (HDHP) or
Consumer-Directed Health Plans (CDHP) with a
Savings Account
CDHP
1%
HDHP
9%
Comprehensive
89%
Note: Comprehensive = plan w/ no deductible or <$1000 (ind), <$2000 (fam);
HDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), no account;
CDHP = plan w/ deductible $1000+ (ind), $2000+ (fam), w/ account.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 17. FEHBP HDHP/HSA Plans Enroll
7,500 Out of 9 Million Covered Lives
Percent
10
6.4
5
0.1
0
Percent of FEHBP plans that
are HDHP/HSAs
Percent of FEHBP enrollees
that are in HDHP/HSAs
Note: As of March 2005.
Source: Government Accountability Office, Federal Employees Health Benefits Program First-Year
Experience with High-Deductible Health Plans and Health Savings Accounts, Washington, DC:
GAO, Jan. 2006; OPM, http://www.opm.gov/insure/handbook/FEHBhandbook.pdf
THE
COMMONWEALTH
FUND
Figure 18. Enrollees Who Chose HDHPs from
the Federal Employees Health Benefits Program
Are More Likely to Earn Higher Incomes
Percent of FEHBP enrollees with incomes > $75,000
75
50
43
23
25
0
HDHP
All FEHBP plans
Source: Government Accountability Office, Federal Employees Health Benefits Program First-Year
Experience with High-Deductible Health Plans and Health Savings Accounts, Washington, DC:
GAO, Jan. 2006.
THE
COMMONWEALTH
FUND
Figure 19. Age Distribution of HDHP
and Other FEHBP Enrollees
Percent FEHBP enrollees
HDHP enrollees
35
All FEHBP enrollees
30
25
20
15
10
5
0
<23
23–34
35–44
45–54
55–64
65–74
75–99
Source: Government Accountability Office, Federal Employees Health Benefits Program First-Year
Experience with High-Deductible Health Plans and Health Savings Accounts, Washington, DC:
GAO, Jan. 2006.
>99
THE
COMMONWEALTH
FUND
Figure 20. Less than Half of Those
Enrolled in Employer-Based High-Deductible
Health Plans Had a Choice
Percent of adults with employer-based coverage
who were offered a choice of health plans
75
58
50
47
45
CDHP
(n=134)
HDHP
(n=334)
25
0
Traditional
(n=1016)
• CDHP and HDHP
owners are less likely
to have a choice of
plans from their
employer
• When they have a
choice, the savings
account is the
leading reason for
choosing CDHP, while
premium cost is the
most frequent reason
for choosing HDHP.
Traditional plans are
chosen for low out-ofpocket costs.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 21. Enrollees of HDHP/CDHPs
Are Less Satisfied with Their Coverage
Percent
Comprehensive
75
HDHP
CDHP
63
50
33*
42*
25
39*
28
32
29* 26*
8
0
Extremely or very
satisfied
Somewhat
satisfied
Not satisfied
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 22. Enrollees of HDHP/CDHPs
Are Less Satisfied with Out-of-Pocket Costs
Percent
Comprehensive
HDHP
CDHP
75
50
25
57* 54*
42
36
12*
18*
31
28*
21
0
Extremely or very
Somewhat
satisfied
satisfied
Not satisfied
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 23. Enrollees of HDHP/CDHPs Are Less Likely
to Stay with Their Current Health Plan If They Had
the Opportunity to Change
Percent of adults 21–64
75
Comprehensive
61
HDHP
CDHP
46*
50
30*
37*
28
33* 33*
21
25
11
0
Extremely or very
Somewhat likely to
likely to stay
stay
Not likely to stay
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 24. Enrollees of HDHP/CDHPs Are Less Likely
to Recommend Their Plan to a Friend or Coworker
Percent of adults 21–64
Comprehensive
75
50
25
HDHP
CDHP
51
34*
22*
26
34* 31
43*
35*
24
0
Extremely or very
likely
Somewhat likely
Not likely
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 25. Employers’ Contributions Lower for
Workers in HSA-Qualified HDHPs; Employees’
Premiums and Deductibles Higher
Dollars
4000
3000
Deductible contribution
Premium contribution
2000
$1,779
1000
1348
0
$3,413
$2,823
553
3413
$933
323
431
610
HSAqualified
HDHP
All
plans^
Worker contribution
2270
HSAqualified
HDHP
All
plans^
Employer contribution
“All plans” refers to all conventional HMOs, PPOs, and POS plans in the survey,
not just HDHP/HRA or HSA-qualified HDHPs.
Source: Calculated based on G. Claxton et al., “What High Deductible Health Plans Look Like: Findings from a
National Survey of Employers, 2005,” Health Affairs Web Exclusive, Sept., 14, 2005; J. Gabel et al., “Health Benefits
in 2005: Premium Increases Slow Down, Coverage Continues to Erode,” Health Affairs, Sept./Oct. 2004.
^
THE
COMMONWEALTH
FUND
Figure 26. Enrollees of HDHP/CDHPs Spend Higher
Percent of Income on Out-of-Pocket Medical
Expenses and Premiums
Percent of adults 21–64 spending > 5% of income
100
10%+ of income
92*
5–9% of income
80
66
60
42*
40
20
0
3
r eh
p
m
Co
s
en
12
9
ive
29*
13*
HP
D
H
53*
31*
9*
HP
D
C
Total
17
23*
13
4
r eh
p
m
Co
s
en
ive
35*
18*
HP
D
H
58*
38*
44*
34
(n = 90)
26*
25
12*
HP
D
C
(n = 61)
33*
10
r eh
p
m
Co
Health problem
s
en
ive
HP
D
H
21
HP
D
C
<$50,000
Annual income
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 27. Enrollees of HDHP/CDHPs Are
More Likely to Delay or Avoid Getting Health Care
When Sick Due to Cost
Percent of adults 21–64
75
Comprehensive
HDHP
CDHP
48*
40*
50
31*
25
35*
31*
(n = 61)
(n = 90)
21
17
42*
26
0
Total
Health Problem
<$50,000 Annual
Income
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 28. Enrollees of HDHP/CDHPs Are More
Likely To Skip Doses to Make Medications Last
Percent of adults 21–64 with prescriptions in last 12 months
Comprehensive
60
35*
40
20
HDHP
26*
15
20
CDHP
32
29
(n = 85)
20
21
28
(n = 50)
0
Total
Health Problem**
<$50,000 Annual
Income
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
** Health problem defined as fair or poor health or one of eight chronic health conditions.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 29. Enrollees of HDHP/CDHPs Are More
Likely to Not Fill a Prescription Due to Cost
Percent of adults 21–64
75
Comprehensive
HDHP
CDHP
50
25
26*
16
33*
20
21
26
(n = 90)
27
32
25
(n = 61)
0
Total
Health Problem
<$50,000 Annual
Income
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 30. Most Insured Do Not Have Quality and
Cost Information to Make Informed Choices
Comprehensive
HDHP/CDHP
14%
16%
14
15
Doctors
16
12
Hospitals
15
12
Doctors
42
54
Hospitals
25
45
Doctors
15
36 (n = 76)
Hospitals
14
32 (n = 76)
Health plan provides information on
quality of care provided by:
Doctors
Hospitals
Health plan provides information on
cost of care provided by:
Of those whose plans provide info on
quality, how many tried to use it for:
Of those whose plans provide info on
cost, how many tried to use it for:
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
THE
COMMONWEALTH
FUND
Figure 31. Cost Conscious Decision-Making,
by Insurance Source
Percent of adults 21–64 who received health care in last 12 months
49
Checked whether plan
would cover care
60*
43
Talked to doctor about
treatment options & costs
55*
Asked doctor to
recommend less costly
prescription drugs
27
44*
23
Checked price of service
Comprehensive
32*
HDHP/CDHP
14
Checked quality rating of
doctor or hospital
19
0
25
50
* Difference between HDHP/CDHP and Comprehensive is statistically significant at p < 0.05 or better.
Source: P. Fronstin, S.R. Collins, Early Experience with High-Deductible and Consumer-Driven
Health Plans: Findings From the EBRI/Commonwealth Fund Consumerism in Health Care Survey,
EBRI Issue Brief, Dec. 2005.
75
THE
COMMONWEALTH
FUND
Figure 32. HSAs Won’t Solve the Cost Problem:
Most Costs Are Concentrated in the Very Sick
Distribution of health expenditures for the U.S. population,
by magnitude of expenditure, 1997
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Expenditure
threshold
(1997 dollars)
1%
5%
10%
50%
U.S. Population
27%
$27,914
55%
$7,995
69%
$4,115
97%
$351
Health Expenditures
Source: A.C. Monheit, “Persistence in Health Expenditures in the Short Run: Prevalence and
Consequences,” Medical Care 41, supplement 7 (2003):III53–III64.
THE
COMMONWEALTH
FUND
Figure 33. Uninsured Rates High Among Adults
with Low and Moderate Incomes, 2001–2005
Percent of adults ages 19–64
75
Insured now, time uninsured in past year
Uninsured now
49
50
16
25
28
24 26
9
9 9
52 53
15 16
28
33 37 37
15 17 18
0
35
11
41
13
11
17
24 28
16 18
13
9
7 9
6 7 9
4
4
3 2
7
3
2001 2003 2005
2001 2003 2005
2001 2003 2005
2001 2003 2005
2001 2003 2005
Total
Low
income
Moderate
income
Middle
income
High
income
Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–
$34,999, middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005, low income is <$20,000,
moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more.
Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem—Findings from the
Commonwealth Fund Biennial Health Insurance Survey, The Commonwealth Fund, Apr. 2006.
THE
COMMONWEALTH
FUND
Figure 34. Distribution of Uninsured
Young Adults 19–29 by Poverty Status, 2004
200% FPL
or more
31%
Less than
100% FPL
40%
100%–
199% FPL
29%
Source: S.R. Collins, C. Schoen, J.L. Kriss et al., Rite of Passage? Why Young Adults Become
Uninsured and How New Policies Can Help, The Commonwealth Fund, updated May 2006.
THE
COMMONWEALTH
FUND
Figure 35. HSAs Won’t Solve the Uninsured
Problem: Income Tax Distribution of Uninsured
5%
(27% tax
bracket)
1%
(30%–39%
tax bracket)
23%
(15% tax
bracket)
55%
(0% tax
bracket)
16%
(10% tax
bracket)
Source: S.A. Glied, The Effect of Health Savings Accounts on Health Insurance Coverage,
The Commonwealth Fund, Apr. 2005.
THE
COMMONWEALTH
FUND
Figure 36. Individual Market Is Not an
Affordable Option for Many People
Adults ages 19–64 with
individual coverage or who
thought about or tried to buy
it in past three years who:
Total
Health
problem
No
health
problem
<200%
poverty
200%+
poverty
34%
48%
24%
43%
29%
Found it very difficult or
impossible to find affordable
coverage
58
71
48
72
50
Were turned down or charged
a higher price because of a
pre-existing condition
21
33
12
26
18
Never bought a plan
89
92
86
93
86
Found it very difficult or
impossible to find coverage
they needed
Source: S.R. Collins, J.L. Kriss et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens
the Health and Financial Well-Being of American Families, The Commonwealth Fund, Sept. 2006.
THE
COMMONWEALTH
FUND
Figure 37. Lacking Health Insurance for Any Period
Undermines Quality and Efficiency
Percent of adults ages 19–64 with at least one chronic
condition*
Uninsured now
75
59
Insured now, time uninsured in past year
Insured all year
58
50
35
27
18
25
16
0
Skipped doses or did not fill
Visited ER, hospital, or both for
prescription for chronic condition
chronic condition
because of cost
* Hypertension, high blood pressure, or stroke; heart attack or heart disease;
diabetes; asthma, emphysema, or lung disease.
Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem—
Findings from the Commonwealth Fund Biennial Health Insurance Survey,
The Commonwealth Fund, Apr. 2006.
THE
COMMONWEALTH
FUND
Figure 38. Adults Without Insurance Have
More Problems With Lab Tests and Records
Percent of adults ages 19–64 reporting the following problems
in past two years:
Insured all year
75
Uninsured during the year
50
25
15
23
10
19
19
30
26
41
0
Test results or
Duplicate tests
Never received
Any lab test/
records not
ordered
lab/diagnostic test
record problem
available at time of
results or delay in
appointment
receiving abnormal
results
Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem—
Findings from the Commonwealth Fund Biennial Health Insurance Survey,
The Commonwealth Fund, Apr. 2006.
THE
COMMONWEALTH
FUND