Lack of health insurance places entire family at risk, study finds


WASHINGTON – If just one member of a family does not have health insurance, it adversely affects the health, emotional well-being and financial stability of the entire household, says a report from the National Academies’ Institute of Medicine.

Roughly 58 million people in the United States are either uninsured or live with a family member who is uninsured.

One in five families have at least one member who is not covered.

“People without insurance generally have less positive experiences with the health system and are less likely to get regular care for themselves or their dependents, even if these dependents are insured,” said Arthur Kellermann, co-chair of the committee that wrote the report.

“The stress of having even one uninsured family member can ripple through the household as other family members cope with their relative’s illness, high medical bills, and financial distress,” he said.

“Moreover, even if every member of a family has insurance today, changes in the plan-holder’s eligibility or employment status can mean sudden loss of coverage for some or all in the household tomorrow,” Kellermann said.

Partial regard. Health insurance, the principal means by which Americans obtain health care, is frequently offered on an individual basis or with only partial regard to family circumstances.

Coverage for dependents under employment-based health plans can be disrupted if plan-holders lose or change jobs, retire, divorce or die.

Public insurance programs are available to cover specific groups, such as children and low-income pregnant women who cannot get private insurance, but these programs typically do not extend coverage to all other family members.

The mismatch between family needs and the conditions under which coverage is available is at the root of many of the negative consequences of being uninsured, the committee found.

Children’s coverage. Children in particular are affected by lack of insurance because they rely on their parents or guardians to obtain both coverage and health care for them.

The negative experiences of uninsured parents in obtaining care for themselves may affect their willingness to take their children for checkups or enroll them in public insurance plans.

More than half of the nation’s 8 million uninsured children are eligible for Medicaid or State Children’s Health Insurance Program but are not enrolled.

When certain states expanded Medicaid coverage to include low-income parents as well as their children, enrollment of children increased more than in states without the parental coverage, the committee found.

However, future expansions of Medicaid and State Children’s Health Insurance Program may be affected by the recent recession, the report said.

There are likely to be more individuals eligible for public coverage as unemployment rises. Facing budget constraints, some states may either stop expanding public coverage or cut it back.

Delaying. Studies demonstrate that uninsured parents delay seeking care for themselves and their uninsured children until the symptoms are more severe. These delays may result in unnecessary hospitalizations for preventable or readily treatable conditions.

Uninsured children are less likely to have a regular source of primary care than insured children, and they use medical and dental services less often.

National data show that 51 percent of uninsured children had a physician visit during the previous year, compared with 76 percent of insured children.

Twenty-one percent of uninsured children had a regular dental checkup, while half of insured children did.

On average, sick newborns without health coverage receive two fewer days of hospital care than those with insurance.

Ripple effect. When parents experience poor physical or mental health, their children’s emotional health and development may suffer as a result.

Studies show that parental depression increases the chances that children will exhibit greater difficulty in learning to socialize, poorer academic performance and school behavior, and higher rates of mood disorders.

Financial factor. Lack of insurance can seriously strain families’ financial stability, the committee found.

Families with no members insured for a year are more than twice as likely as families with full coverage to incur medical expenses that exceed 10 percent of their income.

Most uninsured families cannot afford to buy coverage independently. The median income for two-parent families in which both parents have insurance is $67,000, compared to $30,000 for families in which neither parent has coverage and $14,280 for single parents who lack insurance.

Nonetheless, uninsured families pay more than 40 percent of their medical expenses out of pocket on average. The remainder is absorbed by health care providers, hospitals, charities and the larger community.

Other barriers. Families without full coverage also are disproportionately headed by single parents and are more likely to be immigrants or racial and ethnic minorities.

In addition to lack of financial means, they often face multiple barriers to care, including cultural differences, less education and language barriers.

Private, employment-based health plans increase the likelihood that all family members will be covered, but these plans also have limitations. Changes in the plan-holder’s eligibility or status often disrupt coverage for the entire family.

Families with members in late middle age and approaching retirement are most susceptible to the negative consequences of losing coverage, since they tend to have greater health care needs and higher medical costs than younger families.

Expensive help. Although the Consolidated Omnibus Budget Reconciliation Act offers protection during transitional periods to some of those with workplace coverage, many families cannot afford to pay for it.

Also, the cost of health care is once again rising fast, resulting in higher premiums, co-payments and deductibles.

This may lead more employees to decide they cannot afford coverage for themselves or their families, and more employers to reduce their coverage offerings.

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