An estimated 59.1 million Americans, including one in four adults aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported Nov. 9.
Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]: 1-7).
At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.
About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.
The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.
"All of our measures of uninsurance have increased and increased substantially," Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings. "There are multiple factors contributing to that increase."
The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured.
It found that "half of the uninsured are nonpoor," Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.
The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.
Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.
The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.
Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report.
For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely – 28%, compared with 4% – to forgo needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely – 47% vs. 8% – to skip necessary care because of cost.
More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found. About 16% of currently insured people in that same age group who had a 1- to 3-month coverage gap during the preceding year reported not having a usual source of care, and 26% reported delaying needed care because of cost.
The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.
"People who are uninsured are much less likely to have a regular doctor," said Dr. Frieden. "Middle-aged adults who don't get preventive care enter Medicare sicker," resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes.