Health Insurance Consumer Information

Researchers at Georgetown University Health Policy Institute, working in partnership with the American Diabetes Association (ADA), just completed a report on health insurance problems of people with diabetes. “Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes,” reviews the experiences of 851 people who called the national call center for help with their health insurance problems. Only 1 in 5 callers could be helped.

Case studies from the report are described along with national survey research findings that indicate people with chronic conditions are disadvantaged in health insurance in the U.S. Specifically, people in poor health who lose health insurance tend to be uninsured longer compared to healthy people; and medical debt and medical bankruptcy increasingly are problems of the insured.

Stories of real people in the report add important detail to what is already known. Problems studied were resolved when people could find health coverage that was simultaneously available, affordable and adequate. For most, however, health insurance and other safety net protections — such as COBRA and high-risk pools — often met only one or two of these three requirements, and so did not help. In particular:

• Individual health insurance — 395 people needed coverage in this market but only 15 could buy policies
• COBRA – 377 people lost or were losing job based coverage but only 31 took COBRA
• HIPAA — 87 people were HIPAA eligible but only 11 bought HIPAA coverage
• High-risk pools — 344 people needed coverage and lived in high-risk pool states but only 7 enrolled

The report identified features of health insurance coverage that make it harder for people with diabetes to get and keep coverage during insurance transitions. Barriers to finding new coverage included:

• medical underwriting in individual insurance,
• lack of COBRA premium subsidies for people who lose jobs,
• insurance premium surcharges based on health status, and
• pre-existing condition exclusion periods in high-risk pools.

In addition, people whose health insurance was not changing also had problems — most often they were under-insured. When insurance did not cover test strips or prescription drugs, or when it imposed high-deductibles and other cost sharing, people had trouble getting care necessary to manage their diabetes. Medical and financial consequences of these problems could be severe. In a number of cases, people developed preventable complications requiring hospitalization and/or amassed medical debts they could not afford to pay. The report concluded that the perspective of people with diabetes — or other serious, chronic health conditions — provide an important lens through which to evaluate health insurance. Proposals to change the coverage system need to be considered in light of their impact on sick people.

Click here to read the full report (PDF format, 53 pages, 430 KB) or the executive summary (PDF format, 8 pages, 48 KB).

The press briefing releasing this report can be viewed (with transcript available) at www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1357

This project was supported by grants from the W.K. Kellogg Foundation, the Robert Wood Johnson Foundation, the Commonwealth Fund, and the American Diabetes Association.

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