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October 20, 2009
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Sue Ducat

Uninsured In America: Two Health Affairs Studies Show A Rise For Those Living With Chronic Diseases

Bethesda, MD - The new health care reform legislation is likely to result in mandatory insurance for most Americans. Two papers, released today by Health Affairs, provide a "reality check" about some of those living with chronic conditions who lack health insurance.

Uninsured Adults With Chronic Conditions Or Disabilities: Gaps In Public Insurance Programs
By Steven D. Pizer, Austin B. Frakt, and Lisa I. Iezzoni
Author affiliations:
Pizer and Frakt: U.S. Department of Veterans Affairs
Iezzoni—Massachusetts General Hospital and Harvard Medical School

Who are the uninsured? Where do they live? To answer those questions, the authors analyzed person-level data from the household and medical provider parts of the Medical Expenditure Panel Survey (MEPS) focusing on adults ages 25-61 during the years 2000-2005. They found that 14.8 percent of working-age U.S. residents lacked health insurance, including 11.6 percent of those with disabilities and 11.1 percent of those with health conditions. Uninsurance rates were the highest in the South (18.3 percent) and lowest in the Northeast (10.3 percent). There was a noteworthy income gap: 35.4 percent of those with incomes less than 125 percent of the federal poverty level were uninsured, compared to 14.9 percent with higher incomes. When focusing on low-income Americans with chronic health conditions or disabilities, the authors found that those without federally guaranteed access to Medicaid were about twice as likely to be uninsured as those with such a guarantee. Since 2005 was the latest year studied, the authors felt that these rates would be even higher today, with the country in an economic crisis. Many elements of the reform bills currently before Congress would address these gaps: by increasing the minimum federal income eligibility threshold for Medicaid, many southern residents would be helped, since those state governments set income threshold levels at lower levels than elsewhere in the country. This study was funded from the Agency for Healthcare Research and Quality and the Health Services Research and Development Service of the U.S. Department of Veterans Affairs.

Hypertension, Diabetes, And Elevated Cholesterol Among Insured And Uninsured U.S. Adults
By Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein
Author affiliations:
Wilper — University of Washington
Woolhandler — Harvard Medical School
Lasser — Boston Medical Center
McCormick, Bor, Himmelstein — Cambridge Health Alliance and Harvard Medical School

Hypertension, diabetes, and elevated cholesterol are among the most prevalent chronic diseases in this country today. The authors wanted to determine whether uninsured Americans with these chronic illnesses were less aware of their conditions than their insured peers. Of the three diseases, the most dramatic difference was evident with diabetes. This study analyzed data taken from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006, focusing on those ages 18-64. According to their findings, 46.0 percent of those without insurance were previously unaware of their condition — as opposed to roughly half that number (23.2 percent) of those with insurance. Said the authors, "The elevated risk of very poor diabetes control among the uninsured . . . is worrisome, given evidence of higher costs and elevated risk of cardiovascular disease and mortality with increasing HbA1c [hemoglobin A1c] levels. This finding suggests that insuring uninsured diabetics might reduce future health costs and rates of these complications." Funding for this study was provided by a Health Resources and Service Administration National Research Service Award.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2009 Project HOPE–The People-to-People Health Foundation, Inc.