To offset escalating health insurance costs, employers and insurers have been steadily shifting the burden of paying for medical care to the patients themselves. Higher premiums combined with increasing out-of-pocket expenses have been the primary strategies. The result: More people than ever who have health insurance are considered to be uninsured.

That’s the conclusion of an analysis of health plan data by the Commonwealth Fund. Its study, “The Problem of Underinsurance and How Rising Deductibles Will Make It Worse,” is an extraction from a larger piece of research on health insurance in the U.S. The study is based upon data gathered prior to the launch of Obamacare insurance, so the data offers no comment on how reform act insurance may have affected the numbers. Nonetheless, its implications for the general health of Americans are disturbing.

The report compares those who were considered insured but uninsured in 2003 to those who fit that definition in 2014. The definition is rather subjective; Commonwealth defines it this way:

“People are considered underinsured if they have had health insurance for a full year, but have high deductibles or out-of-pocket expenses relative to their income.”

Essentially, it includes people who say they have insurance but report that they are not using it. They tend not to use their coverage for procedures, drugs, and checkups where there are co-pays, often only using it for a major medical event.

By this definition, the number of those in this category doubled between 2003 and 2010. That number — 31 million — has not changed since 2010, Commonwealth said, presumably as more people were able to afford insurance and afford to use it for medical care. As a percentage of those with insurance, the insured/uninsured rate rose from 12 percent in 2003 to 22 percent in 2010.

Fully 20 percent of those individuals or families who had health insurance through an employer sponsored plan fell into this category. That’s up from 10 percent in 2003. Of those who purchased insurance on their own, 37 percent were insured but realistically uninsured.

“The underinsured rates were higher among those working in small firms with health benefits through their jobs—27 percent were underinsured compared to 14 percent in firms with 100 or more workers,” the report said.

Instant Insights /

31 million Americans with health insurance aren&rsquo;t using it

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31 million Americans with health insurance aren’t using it