By Bob Semro

Lack of health insurance is a problem for many Americans, but for thousands every year it can lead to an avoidable and premature death.

For this and other reasons, the new health care law, the Affordable Care Act, puts new reforms in place to reduce the number of uninsured Americans and improve their access to care.

Estimates on the number of deaths resulting from lack of coverage range from 18,000 to 45,000 annually. A consensus estimate is difficult to come by because studies use different methodologies and focus on different historical time frames and age groups. Inevitably, any number can become the subject of partisan debate.

The Institute of Medicine attributed 18,000 deaths in the United States to lack of insurance coverage in 2000. The Urban Institute found that 22,000 Americans died in 2006, and in the latest report, Harvard Medical School estimated 44,789 Americans died due to lack of coverage in 2009.

Estimates may vary, but it is abundantly clear that people without health insurance coverage have a significantly higher chance of dying prematurely than those who have coverage. Uninsured Americans frequently postpone or forgo doctor’s appointments and other treatments, even when they have a serious disease or condition. Uninsured adults are often unaware of health problems and are less likely to receive effective preventative services.

The number of uninsured Americans last year increased to 49.9 million, or 16.3 percent of the population, according to Income, Poverty and Health Insurance Coverage in the United States: 2010 by the Census Bureau. Some of the numbers from the report:

• 15 percent of all full-time employees, or 14.3 million Americans, are uninsured.
• 28.5 percent of all part-time employees, or 13.7 million Americans, are uninsured.
• 23.1 million whites are uninsured, 8.1 million blacks and 15.3 million Hispanics.

The situation in Colorado was highlighted last Friday in a presentation by Dr. Jonathan Gruber of the Massachusetts Institute of Technology to the directors of the Colorado Health Benefit Exchange. His analysis was based on 2008 data from the Census Bureau and the 2008-09 Colorado Household Survey sponsored by the Colorado Department of Health Care Policy and Financing.

According to Gruber’s preliminary estimates, one in five Coloradans (20.1 percent of the population, or about 850,000 people) is uninsured, which is higher than the national average of 16.3 percent. About 10.3 percent of Coloradans (440,000 people) are insured through public programs, compared to 19 percent nationally.

Other findings presented by Gruber:

• 59 percent of all uninsured Coloradans are employed full time, and 74 percent of them state that the main reason for not being covered is that employer-provided insurance is too expensive.
• 59 percent of the uninsured in Colorado have annual incomes under $21,780 for individuals or $44,700 for a family of four (200 percent of the federal poverty level, or the amount generally considered necessary for self-sufficiency).
• 63 percent of uninsured Coloradans are white, 24 percent are Hispanic and 5 percent are black.
• Almost two-thirds of uninsured Coloradans have been without coverage longer than two years.

Those numbers are of obvious concern. A key question is whether the Affordable Care Act (ACA) has or will have a positive impact in expanding the number of insured in Colorado and across the country.

The new census data show that, nationally, 500,000 more young adults have gained health insurance coverage in 2010 compared to a year earlier. This is largely due to the ACA provision that allows young adults to remain on their parents’ policy until age 26. More young adults will gain coverage as more families become aware of the provision; potentially, 46,000 young Coloradans could be eligible for coverage.

Gruber’s preliminary analysis projects that by 2016, two years after full implementation of the Affordable Care Act, 238,000 men, 185,000 women and 85,000 children in Colorado will fill the ranks of the newly insured (via Medicaid, private, or employer sponsored insurance). In addition, two years after the health insurance exchange is implemented, almost 600,000 Coloradans may obtain coverage through that system.

Even with those gains, it is estimated that more than 350,000 people in Colorado will remain uninsured. Of that number, about 136,000 will be undocumented residents, 100,000 will be Colorado residents not subject to the ACA mandate because of low income or inability to afford coverage, and another 77,000 will choose not to purchase insurance regardless of the ACA mandate to do so.

As with any forecast projected so far into the future, Gruber’s numbers are subject to uncertainty. But they do show the general trend that under the new health care reform law, many more Coloradans will be able to secure coverage in the near future. That coverage will reduce the cost of uncompensated care, allow greater access to health care and improve the quality of life for those that are newly insured. Most importantly, these new reforms will surely reduce the number of those who die prematurely because of lack of insurance.

Even with these advances, some Coloradans will remain uninsured. This underscores the point that the ACA is not an end in itself, but represents a foundation for future reform.

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