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Millions of chronically ill, lacking insurance, can't get needed care

Copies of the study are available at http://www.annals.org/cgi/content/abstract/149/3/170

Embargoed until:
August 4, 2008
5:01 p.m. EST

Contacts:
Andrew P. Wilper, M.D., (503) 260-4948, wilp9522@u.washington.edu
Mark Almberg, (312) 782-6006, mark@pnhp.org

Over 11 million Americans with chronic physical illnesses like heart disease, diabetes and asthma are not getting the medical care they need because they don't have health insurance, a new study shows. The study provides the first national estimate of the number of uninsured adults with these potentially serious but treatable conditions.

According to an article published in the Aug. 5 edition of Annals of Internal Medicine, a leading medical journal, working-age adults with one or more chronic illnesses who reported they were uninsured were nearly four times more likely than their insured counterparts to have not seen a health professional within the past year (22.6 percent versus 6.2 percent). They were also six times more likely to identify a hospital emergency room as their standard site for care when sick (7.1 percent versus 1.1 percent).

"We have made dramatic advances in treatment of chronic illnesses like heart disease and high blood pressure," said Dr. Andrew Wilper, the study's lead author. "But many Americans are locked out of the system because they are uninsured and cannot afford this life-saving care.

"Many of these individuals end up with preventable emergency room visits, hospitalizations, amputations, kidney failure or worse because their chronic condition has gotten out of control," he said.

Wilper's team analyzed data from surveys conducted by the National Center for Health Statistics. The team found that there are 11.4 million nonelderly adults with one or more chronic conditions who lack health insurance, including 1.3 million who survived a heart attack or stroke, 5.9 million with high blood pressure, 1.4 million with diabetes and 3.5 million with asthma or emphysema. Individuals with at least one of these conditions, or with high cholesterol or prior cancer (excluding minor skin cancers), were considered to have a chronic illness.

The 11.4 million figure represents about one-third of the total number of uninsured people in the United States between the ages of 18 and 64. Altogether, about 47 million Americans lacked health insurance in 2006, according to the U.S. Census Bureau.

The authors say they may have underestimated the number of chronically ill persons who lack insurance because the survey did not query participants about depression or other chronic mental illnesses, and because undiagnosed physical diseases among the uninsured may be common.

Uninsured people with chronic illnesses face serious obstacles to getting needed care, Wilper said. But he also observed that people who are enrolled in high-deductible health plans often face similar barriers to getting regular medical attention.

"Some plans, for example, require people to pay medical bills of $5,000 out-of-pocket before their insurance kicks in," he said. "These plans put people in the precarious state of being underinsured, which is not that much better than lacking health insurance altogether."

Wilper, who currently teaches at the University of Washington School of Medicine in Seattle, was a fellow at Harvard University and the Cambridge Health Alliance when the study was carried out.

Dr. Steffie Woolhandler, a co-author of the study, is an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass. Woolhandler noted: "Some claim that uninsured Americans can get the care they need in emergency rooms. But emergency rooms may provide too little, too late for the millions of uninsured with chronic conditions. They need regular medical monitoring, and a steady supply of medications to control their illnesses, and a whole array of services that are out of reach for the uninsured.

"Only national health insurance can fix this broken system and save thousands of lives each year," she said.

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Copies of the study are available at http://www.annals.org/cgi/content/abstract/149/3/170

"Chronically Ill and Uninsured: A National Study of Disease Prevalence and Access to Care in U.S. Adults," Andrew P. Wilper, MD; Steffie Woolhandler, MD, MPH; Karen E. Lasser, MD, MPH; Danny McCormick, MD; David H. Bor, MD; and David U. Himmelstein, MD. Annals of Internal Medicine, August 2008. Annals of Internal Medicine is published by the American College of Physicians.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.