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Bob Semro: A big job ahead

— If you live in Colorado, there's a good chance you don't have health insurance, or enough insurance to cover a serious accident or illness. The latest Colorado Health Access Survey, produced by the Colorado Trust and the Colorado Health Institute, provides a sobering look at the state of health insurance coverage in Colorado.

One-third of Coloradans — more than 1.5 million people — lack health insurance or are underinsured. This problem affects the poor and the middle class, the employed and the unemployed, the young and the old. And even for those who have coverage, the costs of treating the uninsured and the underinsured affect the price they pay for insurance and the care they receive.

 Let's begin with the uninsured.

 Currently, 829,000 people in Colorado do not have health insurance. To put the number in perspective, that is roughly the combined population of Colorado Springs, Fort Collins, Pueblo, Boulder and Grand Junction. To make matters worse, that number has increased by 151,000 people (more than the population of Fort Collins) in just two years.  

According to the survey, the cost of health insurance is the most common reason for being uninsured (reason cited by approximately 85 percent of respondents). In 2011, the average annual premium for family health benefits was more than $15,000, an increase of 9 percent from the previous year. The latest increase comes as family incomes continue to decline — down almost 10 percent since 2008.

Thirty-nine percent of those surveyed said that changing jobs or losing employment was a reason for their being uninsured. In just two years, from 2009 to 2011, the number of Coloradans who had employer-sponsored coverage dropped from 63.7 percent to 57.8 percent.

To break the uninsured population down further, almost 50 percent of the uninsured are between 19 and 54. In terms of ethnicity, 58 percent are categorized as non-Hispanic whites, followed by Hispanics at 33 percent. More than 18 percent are employed. More than 52 percent are unemployed and looking for work while 18 percent are not in the workforce.

Twenty-eight percent of those surveyed visited an emergency room (the most costly form of health care) at least once in the 12 months prior to the survey. That number is up 4 percent in the past two years.

The Affordable Care Act has the potential to cover as many as 540,000 uninsured Coloradans, according to data from the Census Bureau and CHI's 2008-09 Colorado Household Data Survey. According to preliminary results from Dr. Jonathan Gruber, of the Massachusetts Institute of Technology, 185,000 women and 85,000 children will join the ranks of the newly covered two years after the implementation of the Affordable Care Act through Medicaid, private or employer-sponsored insurance. Gruber's study projects that as many as 350,000 will remain uninsured two years after full implementation.

Now let's consider the underinsured.

Underinsured Coloradans are those who have either public or private insurance coverage that does not adequately cover the costs of "medically necessary services" when compared to family income. To put it simply, underinsured Coloradans face out-of-pocket costs that exceed their ability to pay. According to the survey, 674,686 Coloradans are underinsured.

Underinsurance can have a major effect on a family's long-term financial stability. In 2007, illness and medical bills were linked to at least 62 percent of all personal bankruptcies (78 percent of those whose illness led to bankruptcy had insurance coverage when their illness began, and 60 percent of those people had private insurance). Most medically bankrupt families were middle-class before they suffered financial setbacks.

The Affordable Care Act does a number of things that might improve the condition of the uninsured and underinsured. For example, in 2014 the law will require that insurance companies provide coverage regardless of health status or age. It also provides subsidies through tax credits to help lower-income Americans afford coverage through the new Health Insurance Exchanges. The law currently prohibits insurance companies for imposing lifetime caps on benefits, and it places restrictions on annual benefit caps for individual and group health plans until 2014, when they are eliminated.

But the Affordable Care Act is not a panacea for the uninsured and the underinsured; it merely reduces the number in each category. By showing us how many Coloradans live under that cloud, the Health Access Survey shows us the size of the job ahead.

Bob Semro is a health policy analyst with the Bell Policy Center, a nonprofit, nonpartisan think tank based in Denver.