The Costs of Health Care: Understanding America’s Uninsured

Corey Schwartz is the Managing Director of Communispace Health, a new business unit dedicated to helping health care companies collaborate with consumers to create greater impact in the health care insurance, biotech, medical device and diagnostic, and pharma industries.

The Affordable Care Act was enacted to increase the quality and affordability of health insurance and expand access to coverage. Yet, despite the rollout of the ACA, some Americans (around 16%, according to a Jan.-Feb. 2014 Gallup Poll) remain uninsured.

In order to better understand the mindset and motivations of today’s uninsured, we collaborated with a consumer community of 105 uninsured American adults, ages 24 to 64, with a range of incomes and careers. Here’s what we discovered:

They’d have to choose between food and insurance
The choice to go uninsured is not a small one; for the uninsured there are often simply no additional funds for coverage. We found that many of these uninsured Americans choose food over insurance: 53% said that if they were to pay for insurance the money would come from their household food budget. Interestingly, of those same respondents, 61% said that “eating healthy foods” was the number one thing they were doing to ensure they remained healthy in order to not rely on insurance.

They’re scared
Of course, choosing to remain uninsured is not without anxiety. What do the uninsured fear the most? High medical bills are feared by 60%, while 43% fear not getting the necessary care needed and not having access to regular, routine checkups. A recent Kaiser Family Foundation poll supports this notion, finding that 54% of those who are uninsured or who buy their own coverage select plans that cost less, even if those plans offer fewer provider choices. Cost trumps health concerns in both cases. In general, the uninsured tend to shoulder this burden on their own. When asked who, besides themselves, is affected by their lack of health insurance, 49% said no one.

The impending financial penalty is more persuasive than protecting your own health
What will push the uninsured to get coverage? The number one impetus is a penalty for remaining uninsured, 46% reported. Health was the second reason to get coverage, with 40% saying that would tip them to getting covered.

The future of health care is murky and uncertain
While these data points give us some insight into how the uninsured view their health and insurance, we wanted to better understand what they see for the future of health care.

We asked the community to fast-forward 10 years and tell us what they think health insurance will look like in the US. Here are a few responses:

“I think, as people get used to the system, there will be less complaining and confusion. However, I think costs will continue to go up, maybe at a slower pace. I think eventually workplace plans will go away and be replaced by the exchanges.” – Jessie C., 29

“I am not optimistic about the future of health care in the US. I fear that this increased insurance will drive up health costs and discourage qualified people from going into the medical professions. I foresee longer waits for surgeries, medications that are unbelievably expensive and doctors who are frustrated and too busy.” – Ann L., 61

“I think that the future costs will be unsustainable for the consumers. Not enough people are paying in to the system and it will need another big government bailout to stay afloat. The coverage will cost too much, cover too little, and most people won’t like what they have.” – Chris M., 41

“In 10 years’ time I think people will have gotten more used to the idea of having to purchase health insurance, but their feelings towards it will still be the same as it is now.” – Shar R., 30

“I think the health care system will be in flux for a long time to come. I’m not optimistic that the system will improve much, but I think it will go through many changes. I would hope that costs can be contained and equalized so that it can actually become affordable, but I really don’t see that happening.” – Kathy S., 59

What it all means for healthcare providers and insurers?
The uninsureds’ biggest concerns are bearing the burden of high medical costs or penalties and stress around not having coverage. At the same time, there is little optimism within this group about the future of health care.

For an industry where the mandate is let the consumers shop around and decide what they want, health insurers would do well to craft programs aimed at specific needs of the uninsured. This means improving offerings, education about wellness and possibly reconsidering how health care is delivered. But that process begins with further understanding the realities and perspectives of the uninsured.



4 thoughts on “The Costs of Health Care: Understanding America’s Uninsured

  1. Being uninsured is frightening and you’re constantly aware that one wrong twist of the ankle, thirst that is out of the ordinary, etc., and thousands of dollars of bills are ahead. But I have to wonder if some of the reason people are pessimistic about the future of healthcare has something to do with it just being a grey area. Much of the information is overwhelming and unclear. Hey, now new moms can get a breast pump without a diagnosed problem. There’s a nod to preventive care that makes me feel somewhat optimistic.

  2. I live as a Pauper and with my father and am disabled, and have medical bills piling up and I don’t care I have nothing and what assets can they go after, by law hospital medical bills are not criminal debt and as civil debt well its debt they have no hope of collecting.

    Since Florida didn’t expand Medicaid and for me I would get it, I blame the state for racking this debt up at this point on those I owe money to if its hurting the hospitals, skilled nursing facility and medical providers to bad.

  3. Also what makes health care so frightening is that it is like a black box. it is hard to find out what the costs of procedures, they vary even within the same state, and figuring what you will end up paying is quite confusing.
    Furthermore, as everyone knows the entire health care industry is far from transparent. I’d like to know what hospitals are the best at preventing infections, keeping re-admittance as low as possible, etc.
    If we are to continue to have consumers take more responsibility for their own health care, then we should be able to come “apples to apples”.

  4. Florida and Texas both did not expand Medicaid. I live in Texas, and unless I continue to earn about $25,000 annually, I will not qualify for a subsidy.This is very likely to happen, as I work part-time and lost my job. If you earn below $25,000 but not low enough to qualify for un-expanded Medicaid, you literally fall between the cracks and get no support. I would have to pay over $400/month just for health insurance! How is that affordable, when you lost your job and barely making ends meet?!!
    When the time comes, I plan on paying the penalty, and living as healthy as I possibly can—exercising daily and eating lots of fruits and vegetables.

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