The availability of health insurance affects whether and when people receive essential medical treatment, where they receive it, and ultimately, how healthy they are. Although the COVID-19 pandemic had a significant impact on health care use overall, persons without insurance are far more likely than those with insurance to put off or refuse medical care altogether due to cost-related worries. Serious implications may result, especially when chronic diseases or ailments that might be prevented go undiagnosed.
Numerous studies show that persons without insurance are less likely than those with insurance to receive services for significant health disorders and chronic diseases, as well as preventative care. Inequalities between individuals who lack health coverage and those who have persist notwithstanding general reports of lesser use of healthcare services during the epidemic and fewer cost-related barriers.
In 2021, compared to 18.2 percent of people with private insurance and 13.1 percent of people with public coverage, nearly half of non-elderly uninsured persons reported not seen a doctor or other healthcare provider in the previous 12 months.
In comparison to 5.0 percent of adults with private coverage and 6.1 percent of people with public coverage, just over one in five non-elderly adults without insurance reported skipping out on necessary care in the previous year due to cost. Lack of a regular place to go when ill or in need of medical guidance is one factor contributing to the un-insured’s poor access to care.
Due to the high cost of medical care, many uninsured persons do not receive the recommended treatments. Individuals without private insurance were 2.5 times more likely to report delaying or foregoing a necessary prescription medicine in 2021 than individuals with private coverage.
People with and without health insurance are less likely than those with insurance to use all the recommended services, even though both groups receive similar plans for follow-up care after an injury or a new diagnosis of a chronic condition.
In 2021, children without private insurance were more likely than those to forgo needed care owing to cost. Furthermore, compared to 8.1 percent and 8.0 percent for children with public and private coverage, respectively, nearly one-third of children without insurance had not visited a doctor in the previous year.
Because those without insurance are less likely to receive routine outpatient care than those who do, they are more likely to face hospitalizations for preventable health issues and deterioration in their general health. When hospitalized, those without insurance receive fewer diagnostic and therapeutic services and also experience higher mortality rates.
According to research, having health insurance significantly increases one’s access to medical care and lessens the negative repercussions of not having it. Research on the effects of the ACA examined According to research on Medicaid expansion, it had a favorable impact on the low-income population’s access to care, use of services, affordability of care, and financial security.
Medicaid expansion is linked to higher cancer early diagnosis rates, lower cardiovascular mortality rates, and higher chances of quitting smoking.
Uninsured persons have access to a vital health care safety net through public hospitals, community clinics, and health centers, as well as regional providers that work in underserved areas. As a result, not all uninsured people have geographic access to safety net providers, who also have limited resources and service capacities.
High uninsured rates also lead to the closure of rural hospitals, which puts people who live in rural regions at a greater disadvantage when trying to get healthcare.
What financial consequences result from not having insurance?
When uninsured people seek medical attention, they frequently have to pay expensive medical expenses. Due to the poor or moderate wages and scant, if any, savings of the majority of uninsured people, these bills can quickly turn into medical debt.
Over 40 percent of care for those without insurance for a full calendar year is paid for out-of-pocket. Additionally, hospitals frequently charge uninsured individuals charges that are significantly greater than what is covered by both private health insurance and government programs.
Adults under 65 who lack insurance are far more likely than their insured peers to doubt their capacity to cover routine medical bills, large medical expenses, or emergencies.
Compared to around half of people with Medicaid or other public insurance and the same percentage of individuals with private insurance, more over three quarters of non-elderly uninsured adults say they are very or somewhat concerned about paying medical bills if they get sick or have an accident.
The financial security of those without insurance can be put at risk by medical expenditures. Adults without private insurance who are not elderly were more than twice as likely to experience financial difficulties in 2021 as those who did.
Adults without health insurance are also more likely to experience negative effects from medical expenses, such as depleting savings, finding it difficult to pay for needs, borrowing money, or having medical debt brought up by medical bills that are sent to collectors.
While many state governments impose additional requirements on hospitals to extend eligibility for charity care, and federal law requires nonprofit hospitals to provide some level of charity care as a condition of receiving tax-exempt status, not all eligible patients benefit from these programmes because they are unaware of them, do not know how to apply, have their application wrongfully denied, or choose not to apply.
As a result, charity care expenses make up a minor portion of many hospitals’ operational costs. Some but not all hospital charity care and bad debt expenditures are covered by state, federal, and private money. Particularly in states that extended Medicaid, providers have seen uncompensated care expenses decline as a result of the ACA’s expansion of coverage.
According to research, having health insurance increases the low-income population’s access to affordable care and financial security. In comparison to non-expansion states, expansion states have seen greater drops in patients having problems paying their medical expenses, according to numerous ACA studies.
According to a different study, Medicaid expansion dramatically decreased the number of unpaid invoices and the amount of debt forwarded to third-party collection agencies among people living in areas with high percentages of low-income, uninsured people.
In part as a result of measures taken during the COVID-19 pandemic to stabilize coverage, fewer persons lacked health insurance in 2021. Due to the continuous enrollment requirement that has been in place since the beginning of the epidemic, Medicaid coverage increased significantly, which was the main factor driving the gains in coverage.
The number of uninsured people and the uninsured rate decreased as a result of increases in Medicaid and more modest increases in non-group coverage, which partially offset employer coverage decreases. While coverage increases were made across the board, they were especially significant for Hispanics, low-income families, and households with working members, even those with only part-time employees.
These most recent increases in coverage could be undone if the COVID-19 public health emergency (PHE) ends. States will resume Medicaid redeterminations after the PHE expires, which is anticipated to happen sometime next year, and they will dis-enroll anyone who is no longer eligible or who is unable to finish the renewal process even if they are still eligible.
Researchers predict that as a result, between 5 and 14 million people—many of whom had only acquired coverage during the pandemic—could lose their Medicaid coverage. People can complete the Medicaid renewal process and, if determined to no longer be eligible, switch to other coverage thanks to recent budget increases for Navigators and other initiatives to boost outreach and the availability of enrollment assistance.
If the improved Marketplace subsidies remain available, more people may successfully switch from Medicaid to Marketplace coverage, making that coverage cheaper for those who are dropped from Medicaid. Any significant increase in the number of uninsured individuals, however, has the potential to worsen health inequities by undermining the gains in access to care and financial security that come with having health insurance.