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The State of U.S. Health Insurance in 2022: Findings from the Commonwealth Fund Biennial Health Insurance Survey

September 29, 2022

The number and percentage of Americans lacking health insurance is falling to historic lows, thanks to policy changes aimed at helping people get and stay covered during the COVID-19 pandemic, as well as the recent decision by several states to expand Medicaid eligibility under the Affordable Care Act. Still, a large number of people in the United States remain uninsured or inadequately covered, a situation that will worsen when some temporary pandemic measures expire.In this data brief, we present findings from the Commonwealth Fund Biennial Health Insurance Survey to describe the state of Americans' health insurance coverage in 2022. We answer the following questions:How many people experience gaps in their coverage, and how long are those gaps?How many people have insurance but are underinsured?Are health care costs affecting people's decision to get needed care?Are these costs leaving people with medical bills they cannot pay?For the survey, SSRS interviewed a nationally representative sample of 8,022 adults age 19 and older between March 28 and July 4, 2022. This analysis focuses on 6,301 respondents under age 65. Note that because the 2022 edition of the Biennial Health Insurance Survey employed a new sampling method and was conducted mostly online rather than by telephone, as in the past, we are unable to present data on trends in responses over the years

Are Financial Barriers Affecting the Health Care Habits of American Men: A Comparison of Health Care Use, Affordability, and Outcomes Among Men in the U.S. and Other High-Income Countries

July 14, 2022

Whether it's stubbornness, an aversion to appearing weak or vulnerable, or other reasons, men go to the doctor far less than women do. While behavioral and cultural norms may have a lot to do with the care-seeking habits of American men, the fact remains that the United States is the only high-income country that does not ensure all its residents have access to affordable health care. Roughly 16 million U.S. men are without health insurance, and affordability is the reason that people most often cite for why they do not enroll in a health plan. Do income level and financial stress help explain why men do not get needed care and experience worse health outcomes?Using data from the Commonwealth Fund's 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD), we compare health care accessibility, affordability, and health status for adult men in 11 high-income countries. We also examine measures of income and income-related stress, where the data allow, to understand the role income insecurity might play in American men's relatively low use of health care.

2022 Scorecard on State Health System Performance: How did states do during the COVID-19 pandemic?

June 16, 2022

Every year, the Commonwealth Fund's Scorecard on State Health System Performance uses the latest data available to assess how well the health care system is working in every state. We ask such questions as:Do Americans have good access to health care? Does their health insurance enable them to get the care they need to stay healthy? Are they protected from high out-of-pocket health costs?Are Americans getting the right health care, at the right time, and in the right setting? To what extent are they seeking care from emergency departments or other costly settings instead of visiting a primary care provider? Has health care use and spending gone up or down?How healthy is America? How prevalent are high-risk behaviors like smoking or health conditions like obesity that put people at higher risk for poor health? What are Americans' chances of dying early in life from preventable or treatable causes?For the 2022 State Scorecard, we added a new area of inquiry:How well has each state responded to and managed the COVID-19 pandemic? With data that generally reflect the nation's experience since 2020, we were able to provide a window on how state health systems have performed as the pandemic was unfolding.

How Discrimination in Health Care Affects Older Americans, and What Health Systems and Providers Can Do

April 21, 2022

Racial and ethnic discrimination has a significant impact on the health of people of color, affecting mental health and contributing to high blood pressure, negative health behaviors, and early aging. For Black older adults, the cumulative effects of race-related stress experienced over the course of a life can increase the risk for mental and physical health problems.In health care settings, experiences of discrimination can include providers dismissing a patient's symptoms or health concerns, offering different treatment based on a patient's type of insurance, or not providing care in a patient's preferred language.We analyzed findings from the Commonwealth Fund 2021 International Health Policy Survey of Older Adults to examine experiences of racial discrimination in health care settings among Latinx/Hispanic and Black older adults. (See "How We Conducted This Study" for more details.) To provide some cross-national context, we first detail the extent to which older adults in 11 high-income countries believe their national health system treats people unfairly because of race or ethnicity. We then look more in-depth at the United States and report on older Americans' experiences of discrimination and the consequences of health providers' unfair or dismissive treatment. Finally, we consider steps that U.S. health system leaders, health care educators, policymakers, and others can take to address discrimination and dismantle systemic racism in health care.

Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries

April 5, 2022

The maternal mortality crisis in the United States has been well documented: U.S. women have the highest rate of maternal deaths among high-income countries, while Black women are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be a bellwether for the U.S.'s wider failures with respect to women's health and health care.Using data from the Commonwealth Fund's 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD), this brief compares selected measures of health care access and outcomes for women of reproductive age (18 to 49) in 11 high-income countries. After identifying gaps in U.S. health system performance for women in this age group, we explore some of the policies other nations have put in place to ensure more equitable access and better health outcomes. We also suggest policy options for the United States.

Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance

November 17, 2021

In this report, we evaluate health equity across race and ethnicity, both within and between states, to illuminate how state health systems perform for Black, white, Latinx/Hispanic, AIAN, and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. Our hope is that policymakers and health system leaders will use this tool to investigate the impact of past policies on health across racial and ethnic groups, and that they will begin to take steps to ensure an equitable, antiracist health care system for the future.

When Costs Are a Barrier to Getting Health Care: Reports from Older Adults in the United States and Other High-Income Countries: Findings from the 2021 International Health Policy Survey of Older Adults

October 1, 2021

Issue: Unlike older adults in other high-income countries, those in the United States face significant financial barriers to getting health care, despite Medicare's universal coverage. These barriers may affect use of health services as well as health outcomes.Goal: To compare the out-of-pocket spending and care-seeking experiences of older Americans with those of older adults in 10 other high-income countries.Methods: Analysis of findings from the Commonwealth Fund's 2021 International Health Policy Survey of Older Adults.Key Findings: One-fifth of older Americans spent more than $2,000 out of pocket on health care in the past year. Only a small share of older adults in most of the other surveyed countries had such high out-of-pocket health costs. Similarly, a higher share of older Americans reported forgoing health care because of costs. Rates of skipping dental care because of costs were similar for older adults in nations that do not offer coverage of such services, including the U.S.Conclusions: Older Americans pay more for health care and are more likely to not get care for cost-related reasons than people in other high-income countries. Affordability remains a concern and should continue to be a focus of research and policy.

Mirror, Mirror 2021: Reflecting Poorly - Health Care in the U.S. Compared to Other High-Income Countries

August 4, 2021

Issue: No two countries are alike when it comes to organizing and delivering health care for their people, creating an opportunity to learn about alternative approaches.Goal: To compare the performance of health care systems of 11 high-income countries.Methods: Analysis of 71 performance measures across five domains — access to care, care process, administrative efficiency, equity, and health care outcomes — drawn from Commonwealth Fund international surveys conducted in each country and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization.Key Findings: The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care. The U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.Conclusion: Four features distinguish top performing countries from the United States: 1) they provide for universal coverage and remove cost barriers; 2) they invest in primary care systems to ensure that high-value services are equitably available in all communities to all people; 3) they reduce administrative burdens that divert time, efforts, and spending from health improvement efforts; and 4) they invest in social services, especially for children and working-age adults.

As the Pandemic Eases, What Is the State of Health Care Coverage and Affordability in the U.S.? Findings from the Commonwealth Fund Health Care Coverage and COVID-19 Survey, March–June 2021

July 16, 2021

To shore up an economy and health system battered during the COVID-19-induced recession, the U.S. Congress passed four major relief bills in 2020 and 2021. The Biden administration also made a number of administrative changes, including some aimed at helping people enroll in health insurance coverage.After a year of severe job market disruption combined with a massive federal pandemic relief effort, what is the state of health care coverage and affordability in the United States?To answer these and related questions, the survey research firm SSRS interviewed a random, nationally representative sample of 5,450 adults ages 19 to 64 from March 9 through June 8, 2021. This brief reports on the survey's findings about current uninsured rates, pandemic-related coverage loss, and Americans' ongoing struggles to pay their medical bills.

American COVID-19 Vaccine Poll

June 16, 2021

The American COVID-19 Vaccine Poll is a partnership between the African American Research Collaborative and The Commonwealth Fund. The Robert Wood Johnson Foundation supported an expansion of the poll in the Native American community and the W.K. Kellogg Foundation supported expansion in New Mexico.We surveyed over 12,000 Americans to better understand their access to and opinions about the vaccines, as well as messages and messengers that encourage different groups to get vaccinated.

How Auto-Enrollment Can Achieve Near-Universal Coverage: Policy and Implementation Issues

June 10, 2021

Issue: Automatic enrollment is receiving increased policy attention as a means of achieving universal coverage. Auto-enrollment also could have eliminated insurance gaps that occurred during the COVID-19 pandemic. However, it could face resistance from some Americans who would newly be expected to pay premiums. The approach also raises difficult design and implementation issues.Goal: Explore how two auto-enrollment strategies, one affecting all legal residents and another affecting a narrower low-income population, might work.Methods: Based on lessons learned from the Affordable Care Act and understanding of subsidized insurance programs, we explore design and implementation issues, such as how to deem enrollment, how to collect premiums, and which exemptions to permit. We also use the Urban Institute's Health Insurance Policy Simulation Model (HIPSM) to estimate coverage and cost implications of each approach.Key Findings and Conclusions: Both the comprehensive and limited approach to auto-enrollment would require the development of new administrative systems and enhanced marketplace subsidies to improve coverage affordability. Each approach would operate more simply if accompanied by a public insurance option. We conclude that the administrative and financing challenges related to auto-enrollment can be addressed and that a balance between public costs and sufficient political support could be identified.

Racial and Ethnic Inequities in Health Care Coverage and Access, 2013–2019

June 9, 2021

In this brief, we update our 2020 report on coverage and access inequities using 2013–2019 data from the American Community Survey Public Use Microdata Sample (ACS PUMS) and the Behavioral Risk Factor Surveillance System (BRFSS). We examine trends in Black and Latinx/Hispanic disparities across the following measures, with a particular focus on the effects of Medicaid expansion on equity at the state level:adults ages 19 to 64 who are uninsuredadults ages 18 to 64 who went without care in the past 12 months because of costadults ages 18 to 64 who report having a usual health care provider.