Insured (but not really)

The basic promise of health insurance is to protect people from getting wiped out financially if they need costly care. But as our Cover America Tour team is discovering after only a few weeks on the road, insurance often fails to live up to that promise. Just ask Marty (right), a retired Ohio veterinarian who says she spends almost one quarter of her income on health care, or Tina, from Pittsburgh, who says she discovered that her insurance, which she thought covered pregnancy and childbirth, actually didn't. Then there's Tom, a Minnesota potter who says he endured three years of excruciating pain because he couldn't afford $10,000 in deductibles and copays for a hip replacement. He finally got the surgery days after turning 65 and going on Medicare.

A new study from the nonpartisan, non-for-profit Commonwealth Fund confirms that Marty, Tina, and Tom are hardly unique. Based on a 2007 survey of a national sample of 2,616 adults aged 19 through 64, the study found that 20 percent of people who had health insurance were underinsured—a 60 percent increase from the last time the survey was done, in 2003. Being underinsured was defined as spending more than 10 percent of household income on health care (or 5 percent among the poor and near-poor), or having an annual deductible of more than 5 percent of income.

Adding together the underinsured and the just plain uninsured, the Commonwealth Fund study concluded that 42 percent of working-age Americans have inadequate insurance or none at all—up from 35 percent in 2003.

Not surprisingly, underinsured respondents reported considerable difficulty paying for care. Fifty-three percent said that they had gone without some type of medical care in the previous year because they couldn't afford it, and 45 percent said they faced some type of problem with bills for the care they did receive. "In fact," the study's authors said, "underinsured and uninsured adults report access and medical bill problems at remarkably similar rates."

If all this sounds familiar to readers of Consumer Reports, that's because our own national survey of working-age adults, also done in 2007, found very similar results even though it used a completely different methodology. We, too, found that about four in 10 working-age adults were underinsured or uninsured, and that high percentages in both groups postponed medical care and ran into financial trouble paying their health-care bills.

Talk of health care reform is once again in the air during this Presidential campaign season. Consumers Union, the nonprofit publisher of Consumer Reports, believes that no matter how it's structured, a reformed American health system should not force people to choose between going without medical care or going into debt.

—Nancy Metcalf, senior project editor

Visit Cover America Tour to see more videos of the people we're talking to across America and to share your own health care story.