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Uninsured and Underinsured

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Related Guides on this Topic

You may also want to see these guides on related topics: Medicare, Medicaid, and Health Insurance

Introduction

People who are medically uninsured or underinsured face a number of obstacles to both their financial and medical well-being. This includes higher out of pocket costs for care, poorer health outcomes than their insured counterparts, and a greater likelihood that easily treatable ailments will go untreated and become serious medical problems. Rural communities are faced with the task of ensuring the health of their citizens with fewer options for care. It is important for policymakers and service providers to understand issues facing the uninsured and underinsured in rural communities and how communities may work toward reducing this problem among rural citizens.

Frequently Asked Questions

Tools

BCBS Health Issues: The Uninsured
Web site
Links to news and publications on issues related to the uninsured.
Sponsoring organization: BlueCross BlueShield Association

Cover the Uninsured
Web site
Information on events, resources, facts and publications addressing the issue of uninsurance.
Sponsoring organization: Robert Wood Johnson Foundation

Cover the Uninsured: Resources for Individuals
Database
Lists resources and programs by state that can help individuals find health insurance, help paying for prescription medication, and related needs.
Sponsoring organization: Robert Wood Johnson Foundation

Covering Kids & Families
Database
Works to reduce the number of uninsured children and adults who are eligible for low-cost or free health care coverage programs but are not enrolled. Promotes the Back-to-School Campaign - a nationwide effort encouraging parents to enroll their eligible, uninsured children in Medicaid or SCHIP as an important part of preparing for the new school year.
Sponsoring organization: Robert Wood Johnson Foundation

Insure Kids Now!
Web site
Information on free and low-cost health insurance programs for children.
Call toll-free at 877.543.7669.
Sponsoring organization: Health Resources and Services Administration

KaiserEDU
Web site
Detailed resource lists and tutorials on health policy and public health topics, with links to publications, data, and organizations. Topics covered include Medicare, Medicaid, the uninsured, quality of care, and more. Designed for health policy students and faculty.
Sponsoring organization: Kaiser Family Foundation

Key Resources on Health Coverage and the Uninsured
Web site
Contains links to recent resources on health insurance coverage and the uninsured.
Sponsoring organization: Kaiser Family Foundation

MedlinePlus: Health Insurance
Database
Contains a list of resources including news, related issues, organizations, and statistics related to health insurance.
Sponsoring organization: National Library of Medicine

Rural Health Research: Health insurance and the uninsured
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of health insurance and the uninsured, produced by the Office of Rural Health Policy's funded rural health research centers.
Sponsoring organization: Rural Health Research Gateway

State Coverage Initiatives
Web site
Works with states to plan, execute, and maintain health insurance expansions, as well as to improve the availability and affordability of health care coverage.
Sponsoring organization: Robert Wood Johnson Foundation

State Coverage Initiatives for Children
Web site
Map and state-by-state summary of state efforts to provide health insurance coverage for children.
Sponsoring organization: Kaiser Family Foundation

Uninsured: The Basics
Web site
Contains a list of resources for obtaining key data on the uninsured.
Sponsoring organization: Kaiser Family Foundation

Funding

CVS Caremark Community Grants
Grants to support children with disabilities and healthcare for the uninsured.

RGK Foundation Grants
Grants that support projects in the broad areas of education, community, and medicine/health.

Inactive Funding

Inactive Funding Opportunities - Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.

Maps & Map Collections

Health Insurance Coverage Status
Geographic coverage: United States
Printable map that shows percent of population without health insurance by state. Data source: U.S. Census Bureau, Annual Social and Economic Supplement, 2004.
Sponsoring organization: Rural Assistance Center
Date: 2004

Regulations, Forms & Other Useful Documents

Characteristics of the Uninsured: A View from the States
Sponsoring organization: Robert Wood Johnson Foundation
Identifies the number of adults in each state and the number of working adults in each state who do not have health care coverage. Researchers also compared reported gaps in care between insured and uninsured adults in each state, thereby providing an in-depth look at the consequences that adults in America face when they do not have health care coverage.
Date: 05 / 2005

Characteristics of the Uninsured: Who is Eligible for Public Coverage and Who Needs Help Affording Coverage?
Author(s): John Holahan, Allison Cook, Lisa Dubay
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Includes detailed tables showing the characteristics of the uninsured by population group and eligibility status for Medicaid and SCHIP. Reports that a quarter of the uninsured are eligible for public programs but not enrolled. The eligible uninsured population is largely composed of low-income children and parents who would benefit from increased outreach for Medicaid and SCHIP.
Date: 02 / 2007

Chartbook #13: Health Care in Urban and Rural Areas, Combined Years 1998-2000
Author(s): Sharon L. Larson, Steven R. Machlin, Alice Nixon, Marc Zodet
Sponsoring organization: Agency for Healthcare Research and Quality
Examines the differences in health care access, use, and expenses between urban and rural areas. Counties are classified along the urban-rural continuum according to whether they are metropolitan statistical areas (MSAs) and, if not, their proximity to an MSA. An MSA is a large population nucleus with a high degree of economic and social interaction. The categories along the continuum are metro (counties in an MSA), near-metro, near-rural, and rural.
Date: 06 / 2004

Cost of Care for the Uninsured: What do we Spend, Who Pays, and What Would Full Coverage Add to Medical Spending?
Author(s): Jack Hadley, John Holahan
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Finds that uninsured Americans could incur nearly $41 billion in uncompensated health care treatment in 2004, with federal, state and local governments paying as much as 85 percent of the care. It also finds that if the country provided coverage to all the uninsured, the cost of additional medical care provided to the newly insured would be $48 billion.
Date: 05 / 2004

Covering the Uninsured: Growing Need, Strained Resources
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Discusses the number of uninsured Americans and the federal support of health care for the uninsured.
Date: 01 / 2007

Enrolling Children in Medicaid and SCHIP: Insights from Focus Groups with Low-Income Parents
Author(s): Michael Perry, Julia Paradise
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Explores low-income parents’ knowledge of Medicaid and SCHIP, their interest in enrolling their children, and the factors that pose barriers to their participation.
Date: 05 / 2007

Family Coverage Under SCHIP Waivers
Author(s): Samantha Artiga, Cindy Mann
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines the eleven states with programs that cover parents with SCHIP funds and considers them within the context of the states’ efforts to cover children. The information is based on a survey of these eleven states that was conducted in March-April 2007.
Date: 05 / 2007

Going Without: America's Uninsured Children
Sponsoring organization: Robert Wood Johnson Foundation
Documents that uninsured children in virtually every state do not receive all the medical care they need. Children who have health coverage have better access to health care. While millions of children have been helped through Medicaid and the State Children's Health Insurance Program (SCHIP), millions more are still eligible to receive low-cost or free health care coverage, but are not enrolled.
Date: 08 / 2005

Health Care in Rural America
Sponsoring organization: Center for Rural Affairs
Discusses issues related to health insurance coverage and health care costs of rural people. Includes information on the rural uninsured and undersinsured and discusses possible solutions to provide health insurance coverage to the rural uninsured and underinsured.
Date: 10 / 2004

Health Care Opinion Leaders’ Views on Priorities for SCHIP Reauthorization
Author(s): Katherine K. Shea, Karen Davis, Anne K. Gauthier, Rachel Nuzum, Barry Scholl, Edward L. Schor
Sponsoring organization: Commonwealth Fund
The highlights of a Commonwealth Fund survey of experts on issues related to reauthorization of the State Children’s Health Insurance Program (SCHIP) in 2007.
Date: 04 / 2007

Health Care That Works for All Americans
Sponsoring organization: Citizens' Health Care Working Group
Final recommendations by the Citizens' Health Care Working Group to Congress and the President. The recommendations describe a vision and plan for achieving broad-based change in health care in America. Addresses health care cost, coverage and access.
Date: 09 / 2006

Health Coverage for Low-Income Parents
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Summarizes the health coverage of low-income parents, including recent trends, and discusses the current policy challenges related to expanding care for this population.
Date: 02 / 2007

Health Insurance Coverage in America: 2004 Data Update
Author(s): Catherine Hoffman, Alicia Carbaugh, Hannah Yang Moore, Allison Cook
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Chartbook of year 2004 data on health insurance coverage, with special attention to the uninsured. It includes trends and major shifts in coverage and a profile of the uninsured population.
Date: 11 / 2005

Health Insurance Coverage in Rural America: Chartbook
Author(s): Erika C. Ziller, Andrew F. Coburn, Stephenie L. Loux, Catherine Hoffman, Timothy D. McBride
Sponsoring organization: Kaiser Family Foundation
Information on rural-urban differences in health insurance coverage and differences in socio-economic and employment characteristics of those living in rural versus urban counties.
Date: 09 / 2003

Impact of Immigration on Health Insurance Coverage in the United States
Author(s): Paul Fronstin
Sponsoring organization: Employee Benefit Research Institute
Discusses the reasons for the steady increase in the number of uninsured in the United States and the disproportionate numbers of immigrants employed in low wage jobs that often lack employment-based health coverage.
Journal citation: EBRI Notes Volume 26 Issue 6 Pages: 2 - 8
Date: 06 / 2005

Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
Author(s): Timothy D. McBride, Courtney Andrews
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
Discusses the impact that welfare reform had on health insurance coverage for rural and urban areas. Includes information on employment status and health insurance coverage.
Date: 12 / 2005

Improving and Increasing Access to Care: State Health Coverage Expansions Since 2004
Explores state progress in expanding health insurance coverage programs and highlights the most recent innovations in health coverage expansion.
Date: 09 / 2006

Income, Poverty, and Health Insurance Coverage in the United States: 2006
Author(s): Carmen DeNavas-Walt, Bernadette D. Proctor, Jessica Smith
Sponsoring organization: U.S. Census Bureau
Provides the latest income, poverty, and health insurance data from the Current Population Survey. Includes state level data.
Date: 08 / 2007

Living Without Health Insurance
Sponsoring organization: Center for American Progress
Summarizes testimony by the Center for Ameircan Progress (CAP) Senior Fellows Tom Daschle and Jeanne Lambrew in Congress about Americans living—and dying—without health insurance.
Date: 04 / 2007

Long-Term Uninsured in America 2000-2003 Estimates for the U.S. Population Under Age 65
Author(s): Steven B. Cohen, Jeffrey A. Rhoades
Sponsoring organization: Agency for Healthcare Research and Quality
Provides detailed estimates for the U.S. civilian noninstitutionalized non-elderly (under age 65) population that was uninsured for the entire 2000 - 2003 period and identifies groups most at risk of lacking any coverage over that four-year period.
Date: 03 / 2006

Opening Doorways to Health Care for Children: 10 Steps to Ensure Eligible but Uninsured Children Get Health Insurance
Author(s): Dawn Horner, Beth Morrow
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Despite the success of Medicaid and SCHIP in reducing the number of uninsured low-income children, over eight million children remain uninsured. Seventy percent of these uninsured children are eligible for public health coverage. This report lays out a plan for creating a series of enrollment doorways that make enrollment and renewal of children both routine and timely. The recommendations require a combination of both state and federal action.
Date: 04 / 2006

Prescription Drug Safety Net: Access to Pharmaceuticals for the Uninsured
Author(s): Jack Hoadley
Sponsoring organization: National Health Policy Forum
Overview of organized programs that provide access to prescription drugs for the uninsured. Focuses on manufacturer-sponsored pharmacy assistance programs (PAPs) and the federal 340B drug pricing program.
Date: 05 / 2007

Public Health Insurance Cliff for Older Adolescents
Author(s): Harriette B. Fox, Stephanie J. Limb, Margaret A. McManus
Sponsoring organization: Independent Living Research Utilization
Discusses the differences in insurance coverage among adolescent age groups.
Date: 04 / 2007

Role of Medicaid and SCHIP as an Insurance Safety Net
Author(s): Stephen Zuckerman, Allison Cook
Sponsoring organization: Robert Wood Johnson Foundation
Documents the decline in health insurance coverage from employer-sponsored insurance for low-income adults and children between 2000 and 2004.
Date: 08 / 2006

Rural Residents More Likely to be Underinsured
Sponsoring organization: Maine Rural Health Research Center
Multiple studies have demonstrated that rural residents, particularly those living far from urban areas, have high uninsured rates. However, even those with private health insurance coverage can be at risk of having high out-of-pocket health care costs. Understanding the degree to which rural residents are "underinsured" has important implications for rural health policy and practice.
Date: 2006

Spotlight on Uninsured Parents: How a Lack of Coverage Affects Parents and Their Families
Author(s): Karyn Schwartz
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines health coverage, access and the financial impacts of health care for low-income parents and their families.
Date: 06 / 2007

State of the States: Rising to the Challenge
Sponsoring organization: AcademyHealth
Discusses the number of uninsured in each state. Includes a section on “Access Barriers Persist in Rural Areas” on pages 12-13.
Date: 01 / 2008

Study Shows Uninsured Receive Less Care and Experience Worse Outcomes
Author(s): Jack Hadley
Sponsoring organization: American Medical Association
Documents that people who are uninsured receive less care and have worse outcomes following an accident or the onset of a new chronic condition than those with insurance.
Date: 03 / 2007

Threadbare: Holes in America's Health Care Safety Net
Author(s): Catherine Hoffman, Susan Starr Sered
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Describes the impact of health care insurance coverage gaps in our safety net through the perspectives of those who provide care to the uninsured and first-hand accounts of the uninsured who are seeking care.
Date: 11 / 2005

Trends in Uninsurance Among Rural Minority Children: Key Facts
Sponsoring organization: South Carolina Rural Health Research Center
This is the Key Facts from the report. While efforts to reduce the number of children lacking health insurance, such as SCHIP, have demonstrated much success, there continue to be pronounced disparities among both minority and rural children in having health insurance coverage.
Date: 2005

Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality
Author(s): Stan Dorn
Sponsoring organization: Urban Institute
Reports on the greater risk of death due to the absence of health insurance and illustrates its general order of magnitude.
Date: 01 / 2008

Uninsured and their Access to Health Care
Sponsoring organization: Kaiser Family Foundation
Provides a fact sheet about the uninsured, including charts and statistics.
Date: 10 / 2007

Uninsured in America, 1996–2006: Estimates for the U.S. Civilian Noninstitutionalized Population Under Age 65
Author(s): Jeffrey A. Rhoades, May C. Chu
Sponsoring organization: Agency for Healthcare Research and Quality
Presents estimates on the uninsured in America under age 65 for calendar years 1996 through 2005, as well as the first half of 2006.
Date: 06 / 2007

Uninsured: A Primer; Key Facts About Americans Without Health Insurance
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Reviews the basic profile of the uninsured population, how they receive care, the latest trends in health insurance coverage, and what the options are for increasing coverage.
Date: 10 / 2007

Who are the Uninsured? A Consistent Profile Across National Surveys
Author(s): Catherine Hoffman, Karyn Schwartz
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines the differences in the estimates of the uninsured population from three major surveys and finds that the estimates are actually more consistent than what is often perceived. In addition, the analysis shows that who the uninsured are does not vary much across national surveys.
Date: 08 / 2006

Organizations

Center for Studying Health System Change (HSC)
Nonprofit/Foundation
Works to inform health care decision makers about changes in the health care system at both the local and national levels and the effects of such changes on people.

Economic Research Initiative on the Uninsured (ERIU)
Academic/Research
Initiates, commissions, and disseminates original research to spark new discussions on health coverage issues. Located at the University of Michigan and funded by the Robert Wood Johnson Foundation.

Kaiser Commission on Medicaid and the Uninsured
Nonprofit/Foundation
Provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured.

Research Data Assistance Center (ResDAC)
Federal government
Provides free assistance to academic and non-profit researchers interested in using Medicare, Medicaid, SCHIP, and Medicare Current Beneficiary Survey (MCBS) data for research.

State Health Access Data Assistance Center (SHADAC)
State/regional organization
Helps states monitor rates of health insurance coverage and understand factors associated with uninsurance. Provides policy analysis and technical assistance to states that are conducting their own health insurance surveys and/or using data from national surveys.

Terms & Acronyms

CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.

Medicaid Federal assistance program that helps pay for medically necessary services for needy and low income individuals. The program uses state and federal funds to compensate medical providers serving these populations.

Medicare Federal health care insurance program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.

Safety Net Support for healthcare. External support consists of local taxes, state and federal aid, and private programs or donations. Internal strategies adopted by health care facilities include increasing or stabilizing the supply of physicians in the community, changing the scope of services, forging cooperative relationships with other rural providers, and merging with providers outside the community.

SCHIP (State Children's Health Insurance Program) A State and Federal partnership to help children without health insurance, many of whom come from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance.

Underinsured People with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.

Article Searches & Bibliographies

RAC Documents Search: Uninsured and Underinsured

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Page last updated 5/13/2008
Topic last reviewed 10/9/2007

About this Page
Credits

Developed by:
Holly Gabriel
holly@raconline.org

Thanks goes to:
Alana Knudson, PhD, Associate Director for Research, Center for Rural Health, University of North Dakota School of Medicine and Health Sciences



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