The Health Benefits of Health Insurance

Having health insurance impacts our health in positive ways.  People who have health insurance are more likely to access care when they need it, have better health outcomes, and be free of major medical debt.  Not having health insurance is a key barrier to care for the uninsured.  There are new opportunities on the horizon through the Patient Protection and Affordable Care Act (ACA) for more people to gain access to health insurance. So, it is important to understand the benefit from of enrolling in health insurance.

Who is Uninsured?

The U.S. Census reports that there are 48.6 million people who do not have health insurance.[i]  Poverty is the biggest risk factor for being uninsured, and most people without insurance are members of working families.[ii]  Many low-wage employers do not offer health insurance to workers and their families.  Some access public health insurance such as Medicaid and Children’s Health Insurance Program (CHIP).  However, many do not access these programs either because they are not eligible or because they face barriers in enrolling.  Some may not be eligible due to their immigration status. Others may not meet the income guidelines or demographic criteria like needing to be a child, pregnant woman, or parenting adult. Those who are eligible still may not enroll due to barriers such as language, transportation, stigma, fear, and lack of knowledge.  There is more and more evidence that those who are uninsured experience unequal health access and poor health outcomes. 

Accessing and Using Health Services

When people have to pay more for health services, they use them less.[iii]  People who have health insurance and people who do not have insurance tend to have the same perception about whether or not they need medical care for symptoms they are experiencing. However, people who do not have insurance are less likely to actually get the care they believe they need.[iv] When people have insurance, they are more likely to seek and receive timely, preventive care.[v]  They are less likely to go to the hospital for a condition that could have been avoided.[vi] And they are more likely to have a regular source of care.[vii]

Better Health Outcomes

People who have health insurance not only access health care more often, but they also have better health.  It is incorrect to believe that when people have to pay more for health care, they take better care of themselves in order to avoid getting sick and paying for health care.  Making people pay more for health services does not get them to change their health behaviors.[viii]  In fact, evidence shows that having health insurance and paying less for care actually improves people’s health and improves some of their health behaviors such as adhering to medications.[ix] A classic study called the Health Insurance Experiment noted improvements in health for low income people, specifically, who receive no-cost care.  The study concluded that low income patients, especially those with a chronic disease, should pay little to no cost for health services.[x]

Medical Bills

Health insurance affects not only physical and mental health, but also financial health. People who seek care without health insurance end up with high medical bills that usually leave them in debt.[xi]  One study showed that people with access to Medicaid are less likely to borrow money or have a bill sent to collections due to medical expenses than uninsured people who are not able to access Medicaid.[xii]  Stress related to not being able to afford basic needs can, in and of itself, take a toll on physical and mental health (see HOP’s article on the Social Determinants of Health).  Expansion of coverage to those who are uninsured will likely decrease this strain on finances and credit.[xiii]

We can look to many studies that show the value of health insurance, including improved access, better outcomes, and lower cost of care.  Two states, Oregon and Massachusetts, have further shown benefits of health insurance.  A study in Oregon compared the health and well-being of the insured compared to the uninsured.  In Massachusetts, improved health and wellbeing through health insurance access is supported by outreach and enrollment programs throughout the state.

Learning from Oregon

In 2008, Oregon began giving otherwise ineligible uninsured, low-income adults a chance to apply for Medicaid using a lottery system. The Oregon Health Insurance Experiment looked at the effect of public health insurance coverage on health care use, individual finances, and health outcomes.  The study did this by comparing the people who were covered through the lottery to those who were not.  Those who gained health insurance through the lottery system experienced many benefits.  For example, they used primary, preventive, and hospital health services more often.  They had better self-reported physical and mental health.  And they had less out-of-pocket medical expenses and less medical debt. [xiv]  Findings from this study suggest that low-income, uninsured people could benefit from gaining access to Medicaid.

Learning from Massachusetts

We can also learn from the experience of Massachusetts, where almost everyone has had health insurance coverage since 2006.  As a result of expanded access, more adults are now receiving preventive care services and reporting a usual source of care.[xv]  Outreach and enrollment efforts are credited with being a main reason for the success of Massachusetts’s health reform. [xvi]  Community health centers, hospitals, and nonprofit agencies across the state provided outreach and enrollment assistance to people who needed support with enrollment.  The success of these efforts can be traced to the outreach workers who were familiar with the communities they served.  Outreach workers are successful when they build strong, trusting relationships with the communities they reach. Massachusetts not only shows the value of health insurance, but it also shows the value of outreach in connecting the uninsured to coverage and care. 

Outreach will Connect Uninsured to New Opportunities for Coverage

Outreach workers have an important role in helping people who are uninsured navigate health insurance options, enroll in programs, and use health services.  The ACA will provide new opportunities for individuals and families to get health insurance.  There are three main ways this expanded access will happen: expansion of employer-based coverage, Medicaid expansion, and the development of Health Insurance Marketplaces (or Exchanges).  Outreach programs will be key in raising awareness, educating, and assisting eligible individuals and families.  Still, some people, such as undocumented immigrants and Legal Permanent Residents living in the U.S. for less than 5 years, will not be eligible for public health insurance in most states and will still be unable to afford private insurance. While community outreach programs and workers are educating and assisting with health insurance enrollment, they also remain critical for helping the remaining uninsured be able to access care.

Health Outreach Partners has created a number of resources to support outreach programs in connecting underserved populations to health insurance and access to health care:

• Making the Most of Public Health Insurance Benefits: Getting Eligible Individuals and Families Enrolled and Connecting them to Care
• Connecting Underserved Populations to Health Insurance  
• Public Health Insurance Outreach Curriculum
• Connecting Eligible Immigrant Families to Health Coverage and Care: Key Lessons from Outreach Workers
• Innovative Outreach Practices:
  • Got Coverage? HCFA’s Phone-a-thon to Increase Enrollment
  • Prescription for Coverage: Provider Referrals for Insurance Coverage
  • Increasing Access through Patient Benefits Outreach in 10 Years of Innovative Practices: A Collection of Outreach Strategies from the Field

 

Contact us for training and consultation related to Public Health Insurance Outreach.