Raising premiums and other costs for Oregon health plan enrollees drove many to drop out.

The Oregon Health Plan was created to be a sustainable program that could weather budgetary storms without having to cut enrollees from Medicaid. A 2003 redesign of the program increased premiums, raised cost sharing, and imposed rigid premium payment deadlines for members in the "Standard" version of the program but not for members of the "Plus" version. This paper adds two years of longitudinal data to a previous study on the impacts of these changes. It shows that the redesign was a key factor driving a 77 percent disenrollment rate in the Standard program, from a high of 104,000 enrollees in February 2003 to just 24,000 by the end of the study period, November 2005. Those who were in the Standard plan when the reduced benefits and higher member costs went into effect were also nearly twice as likely to have unmet health care needs compared to those in the Plus plan. These changes underscore that in a period of economic downturn, policy makers must understand the impact of increased cost sharing on vulnerable populations.

Health care disconnect: gaps in coverage and care for minority adults. Findings from the Commonwealth Fund Biennial Health Insurance Survey (2005).

Analysis of the Commonwealth Fund Biennial Health Insurance Survey (2005) finds that uninsured rates for Hispanic and African American adults are one and-a-half to three times greater than the rate for white adults. Nearly two-thirds (62%) of working-age Hispanics and one-third (33%) of African Americans were uninsured at some point during 2005, compared with 20 percent of working-age whites. Hispanics are particularly disconnected from the health care system, being substantially less likely than whites to have a regular doctor, to have visited a doctor in the past year, or to feel confident about their ability to manage their health problems. African Americans are significantly more likely than whites to visit the emergency room for non-urgent care and to experience serious problems with medical bills and medical debt. Along with expanded insurance coverage, policies promoting continuity in patients' relationships with health care providers also are needed to reduce disparities in access.

Paying more for less: older adults in the individual insurance market: findings from the Commonwealth Fund Survey of Older Adults.

The Commonwealth Fund Survey of Older Adults reveals that adults ages 50 to 70 who rely on the individual insurance market for health coverage pay much higher premiums than their counterparts with employer coverage or Medicare. The survey found that in 2004, more than half (54%) of older adults with individual coverage spent $3,600 or more annually on premiums. A quarter (26%) spent $6,000 or more a year. In contrast, only 17 percent of older adults with employer coverage and 6 percent of those covered by Medicare spent $3,600 or more on premiums. Moreover, individual coverage often provides poor access to care and entails high out-of-pocket expenses for older adults, making it a particularly unaffordable option for people who are older, have low incomes, or who have chronic health problems.

Seeing red: Americans driven into debt by medical bills. Results from a National Survey.

New analysis of the 2003 Commonwealth Fund Biennial Health Insurance Survey reveals that an estimated 77 million Americans age 19 and older--nearly two of five (37%) adults--have difficulty paying medical bills, have accrued medical debt, or both. Working-age adults incur significantly higher rates of medical bill and debt problems than adults 65 and older, with rates highest among the uninsured. Even working-age adults who are continually insured have problems paying their medical bills and have medical debt. Unpaid medical bills and medical debt can limit access to health care: two-thirds of people with a medical bill or debt problem went without needed care because of cost--nearly three times the rate of those without these financial problems.

Insured but not protected: how many adults are underinsured?

Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19-64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35 percent (sixty-one million) were under- or uninsured. These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage.

Unequal access: insurance instability among low-income workers and minorities.

Analysis of health insurance coverage and employment patterns from 1996 through 1999 reveals even higher uninsured rates and greater insurance instability among low-income adults and minorities than had been previously documented. Most low-income adults worked during the four years, but many had no or only intermittent job-based coverage. Low-income Hispanic adults were particularly hard hit: more than one-third (37%) of this group were never insured with private coverage, even though they worked all four years. Policies that expand coverage to low-income families could help reduce racial and ethnic disparities in access to care.