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Decreasing the number of uninsured is a key goal of the Affordable Care Act (ACA), which provides Medicaid coverage to many low-income individuals in states that expand and Marketplace subsidies for individuals below 400% poverty. The number of uninsured people increased from 2000 to 2010 due to decreasing employer sponsored insurance coverage and rising health care costs, and growth in the uninsured accelerated during recessionary periods when people lost their jobs. As of 2014, the ACA expanded coverage to millions of previously uninsured people through the expansion of Medicaid eligibility and establishment of Health Insurance Marketplaces. Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. The number of uninsured people increased throughout most of the past decade due to decreasing employer sponsored insurance coverage and rising health care costs.
The share of the nonelderly population with employer-sponsored coverage declined steadily between 2000 and 2010, dropping nearly ten percentage points over the decade.1 In 2011, this trend ended as the share with employer-sponsored coverage held nearly constant at around 58% between 2011 and 2013. The share of people covered by Medicaid increased significantly during the recent recession due to the weak economy and loss of jobs, which led to declining family incomes and decreasing employer-sponsored coverage among families. In 2013, the uninsured rate among nonelderly individuals was 16.7%, a level comparable to pre-recession uninsured rates (Figure 1). Under the ACA, as of 2014, Medicaid coverage is expanded to nearly all adults with incomes at or below 138% of poverty in states that expand, and tax credits are available for people who purchase coverage through a health insurance Marketplace. Coverage gains from 2013 to 2014 were particularly large among poor and low-income individuals and people of color, groups that had high uninsured rates prior to 2014. Most Americans obtain health insurance coverage through an employer, but not all workers are offered employer-sponsored coverage or, if offered, can afford their share of the premiums.
Some individuals eligible for assistance may not sign up for coverage due to several factors, including lack of knowledge about their eligibility or enrollment barriers. Undocumented immigrants are not eligible for Medicaid and are barred from purchasing coverage in the Marketplace.14 While lawfully-present immigrants under 400% FPL are eligible for Marketplace tax credits, only those who have passed a five-year waiting period after receiving qualified immigration status can qualify for Medicaid. Low-income working families make up over 40% of the remaining uninsured.15 Reflecting income and the availability of public coverage, people who live in the South or West are more likely to be uninsured. As of the end of 2014, over seven in ten of the uninsured have at least one full-time worker in their family, and an additional 12% have a part-time worker in the family (Figure 5).
Individuals below poverty are at the highest risk of being uninsured (the poverty level for a family of three was $19,055 in 2014). While a plurality (45%) of the uninsured are non-Hispanic Whites, people of color are at higher risk of being uninsured than non-Hispanic Whites.
Uninsured rates vary by state and by region, with individuals living in the South and West the most likely to be uninsured (Figure 6 and Appendix Table A).
Most people who remained uninsured in 2014 had been without coverage for long periods of time, with 29% reporting that they had been uninsured for one to five years, 24% reporting they had been uninsured for more than five years, and 18% reporting that they had never had coverage.17 People who have been without coverage for long periods may be particularly hard to reach in outreach and enrollment efforts. Over a quarter of uninsured adults (27%) in 2014 went without needed care in the past year due to cost (Figure 7). Receiving needed care is especially important for the uninsured since they are generally not as healthy as those with private coverage. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being.
Uninsured low- and middle-income nonelderly adults were also much more likely than their insured counterparts to lack confidence in their ability to afford usual medical costs and major medical expenses or emergencies.
While millions of people have gained coverage under the ACA provisions that went into effect in 2014, over 32 million nonelderly individuals remained uninsured in 2014. Going without coverage can have serious health consequences for the uninsured because they receive less preventive care, and delayed care often results in more serious illness requiring advanced treatment. EndnotesKaiser Family Foundation analysis of the 2000-2012 National Health Interview Surveys. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.
Over the past 15 years K&M Development has built 40+ luxury homes in some of the Bay Area's top residential neighborhoods (Hillsborough, Palo Alto, Los Altos, Saratoga, and Cupertino).
Adults aged 18a€“64 were more than twice as likely as adults aged 65 and over to not have taken medication as prescribed to save money. Among adults aged 18a€“64, uninsured adults were more likely than those with Medicaid or private coverage to use strategies to save money on prescription drugs. Among adults aged 65 and over, asking a doctor for a lower-cost medication to save money varied more by insurance type compared with other strategies.
To save money, adults who were poor or near poor were twice as likely as adults who were not poor to not take medication as prescribed. Six percent of adults aged 18a€“64 used alternative therapies to save money on prescription drugs compared with 2.3% of adults aged 65 and over. There were no differences by health insurance coverage in the percentages of those who bought prescription drugs from another country to save money.
Previous studies have found that more than 48% of Americans took at least one prescription drug in the past month (6). Health insurance coverage: NHIS respondents were asked about their health insurance coverage at the time of interview. Poverty status and percentage of poverty level: Based on reported and imputed family income, family size, and the number of children in the family, and, for families with two or fewer adults, on the age of the adults in the family. NHIS is designed to yield a sample representative of the civilian noninstitutionalized population of the United States, and this analysis used weights to produce national estimates. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Improve patient adherence and outcomes with a simple solution for managing even complex medication regimens: Parata PASS Pack. Parata PASS Pack gives patients and caregivers an easy way to manage medications with convenience, confidence and control.
Parata PASS packaging facilitates medication therapy management, creates regular opportunities for your pharmacy to engage patients, and promotes conversation between the pharmacy and a patient’s care team.
Health care providers and payers are looking for partners who can help improve patient outcomes and reduce health care costs. Leading pharmacists are using Parata PASS Pack to impact medication adherence and administration, improve patient outcomes, and grow their businesses.
The ACA’s major coverage provisions went into effect in January 2014 and led to significant coverage gains. Public programs provided a safety net during the Great Recession and prevented many from becoming uninsured. The ACA also includes reforms to help people maintain coverage and make private insurance affordable and accessible.
In 2014, 48% of uninsured adults said the main reason they were uninsured was because the cost was too high.

In 2014, over 8 in 10 were in a family with a worker, and over 5 in 10 have family income below 200% of poverty. Over a quarter of uninsured adults in 2014 (27%) went without needed medical care due to cost.
In 2014, nearly 36% of low- and middle-income uninsured adults said they had problems paying medical bills. The recent recession led to a steep increase in uninsured rates from 2008 to 2010 as a high jobless rate led millions to lose their employer sponsored coverage.
This break in trend was likely due to uptake of the ACA provision that allowed young adults to continue as dependents on parents’ private plans until age 26. Between 2008 and 2013, over 11 million people—primarily children—gained Medicaid coverage.3 These gains offset some of the loss of employer coverage over the period.
Still, many uninsured individuals had been uninsured for long periods, often five years or more,4 indicating that their lack of coverage was related to forces outside the recession. Medicaid and the Children’s Health Insurance Program (CHIP) cover many low-income individuals, particularly children, and financial assistance for Marketplace coverage is available for many moderate-income people.
In 2014, 48% of uninsured adults said that the main reason they lacked coverage was because it was too expensive.
Among adults who were uninsured in fall 2014, 63% reported that they did not attempt to gain ACA coverage in 2014.
Almost three quarters of uninsured workers (71%) are self-employed or work for firms that do not offer health benefits.9 Of those who do work for firms that offer coverage, the most common reason for remaining uninsured was that the coverage was unaffordable. In total, over eight in ten of the uninsured are in low- or moderate-income families, meaning they have incomes below 400% of poverty (Figure 5).
Only emergency departments are required by federal law to screen and stabilize all individuals. These bills can quickly translate into medical debt since most of the uninsured have low or moderate incomes and have little, if any, savings.
Low- and middle-income nonelderly adults who remained uninsured in 2014 were twice as likely as those who gained coverage in 2014 and those who had coverage since before 2014 to have problems paying medical bills (Figure 8). Over two-thirds (68%) of the low- to middle-income uninsured are not confident that they can pay for the health care services they think they need, compared to 34% among the newly insured and 24% among the previously insured.35 The uninsured live with the knowledge that they may not be able to afford to pay for their family’s medical care, which can cause anxiety and potentially lead them to delay or forgo care. Many of these people are ineligible for ACA coverage, either because of their immigration status or because their state did not expand Medicaid. Utilizing well established relationships with key contractors, K&M Development consistently produces high quality custom homes for sale as well as for residential owners. Some adults reduce prescription drug costs by skipping doses and delaying filling prescriptions (2). Poverty categories are based on the ratio of the familya€™s income in the previous calendar year to the appropriate poverty threshold (given the familya€™s size and number of children) defined by the U.S.
Respondents reported whether they were covered by private insurance (obtained through the employer or workplace, purchased directly, or purchased through a local or community program), Medicare, Medigap (supplemental Medicare coverage), Medicaid, Children's Health Insurance Program (CHIP), Indian Health Service (IHS), military coverage (including VA, TRICARE, or CHAMPa€“VA), a state-sponsored health plan, another government program, or any single-service plan. Family income was imputed for 22.4% of persons in 2011 using NHIS imputed income files (11). NHIS data are collected continuously throughout the year for the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS), by interviewers from the U.S. Medication cost problems among chronically ill adults in the US: Did the financial crisis make a bad situation worse? Despite the recession's effects on incomes and jobs, the share of people with high medical costs was mostly unchanged. The financial burden from prescription drugs has declined recently for the nonelderly, although it is still high for many. Multiple imputation of family income and personal earnings in the National Health Interview Survey: Methods and examples [PDF - 814 KB]. Many pharmacies using PASS Pack as a cornerstone of successful medication adherence programs report adherence rates over 95 percent, dramatic improvements in patients’ health outcomes, and reduced hospital readmissions.
PASS Pack sets your pharmacy apart from the competition and positions you to serve new markets and patient segments. Click here to download the Parata PASS spec sheet for details, including product dimensions and space and electrical requirements. The number of uninsured nonelderly Americans in 2014 was 32 million, a decrease of nearly 9 million since 2013. As the economy improved and early ACA provisions went into effect, the number of uninsured people declined slightly from 2010 to 2013. Evidence through 2014 and the beginning of 2015 shows substantial gains in public and private insurance coverage and associated historic decreases in uninsured rates in the first full year of ACA coverage. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for public coverage.
Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases. Medicaid and CHIP prevented steeper drops in insurance coverage, as many Americans became newly eligible for these programs when their income declined during the recession. With the major ACA coverage provisions that went into effect in 2014, many are newly-insured. Data through early 2015 suggest that the ACA has helped expand coverage to millions of previously uninsured people, with historic drops in the uninsured rate.
Declines have continued into 2015, with preliminary data indicating an uninsured rate of 10.7% in the first quarter of 2015 (Figure 2), the lowest rate in decades. Among racial and ethnic groups, Hispanics and Blacks had the largest declines in uninsured rates, and all people of color generally had larger coverage gains than Whites.
However, Medicaid eligibility for adults remains limited in some states, and few people can afford to purchase coverage on their own without financial assistance. Eligibility is also a barrier: 12% of uninsured adults mentioned work-related reasons, such as being unemployed or not having an offer through work, and 13% said they were told they were ineligible or could not get coverage due to their immigration status. This variation reflects different economic conditions, state expansion status, availability of employer-based coverage, and demographics. Uninsured adults were also more likely to face negative consequences due to medical bills, such as using up savings, having difficulty paying for necessities, borrowing money, or having medical bills sent to collection. Others may be eligible but either do not know of the new coverage options, have had difficulty navigating the enrollment process, or opted not to take up coverage.
The ACA has helped to lower the number of uninsured Americans, but monitoring coverage changes, coverage affordability, and who is left out of coverage expansions is still important. Some cost-reduction strategies used by adults have been associated with negative health outcomes.

Adults who do not take prescription medication as prescribed have been shown to have poorer health status and increased emergency room use, hospitalizations, and cardiovascular events (3,4). This information was used to form two health insurance hierarchies: one for those under age 65 and another for those aged 65 and over (10). Point estimates and estimates of corresponding variances for this analysis were calculated using SUDAAN software (13) to account for the complex sample design of NHIS.
For patients or caregivers managing medications at home, PASS Pack reduces unnecessary health risks that can accompany incorrect or forgotten doses. Our nurse consultants work with you to create sound strategies for entering new markets, and our online Business Growth Toolkit provides ready-to-use marketing materials to promote your use of Parata PASS Pack. This fact sheet describes trends in coverage leading up to and after the ACA expansions, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage. From 2011 to 2013, uninsured rates dropped slightly as the economy improved and early provisions expanding coverage under the ACA went into effect.
Coverage gains were particularly large among low-income people living in states that expanded Medicaid.
Children, who already had a low uninsured rate due to relatively higher eligibility levels for public coverage, experienced a small decline in the uninsured, while the uninsured rate among nonelderly adults dropped significantly.
In addition, uninsured rates dropped across states that chose to expand Medicaid and states that chose not to expand Medicaid, but they dropped more in expansion states (see Appendix for state-by-state data on changes in the uninsured rate). Some people who are eligible for coverage under the ACA may not know they can get help, and others may still find the cost of coverage prohibitive.
Few uninsured adults said they were uninsured because they do not need coverage, oppose the ACA, or would rather pay the penalty (Figure 4). The disparity in insurance coverage is especially high for Hispanics, who account for 19% of the total population but more than a third (34%) of the uninsured population. Affordability of coverage, even with the availability of financial assistance, remains a barrier to insurance, with remaining uninsured adults naming cost as an ongoing major reason for not being insured. For example, adults who do not take prescription medication as prescribed have been shown to have poorer health status and increased emergency room use, hospitalizations, and cardiovascular events (3,4).
This study provides a baseline to track strategies used by adults to reduce their prescription drug costs on a national level for all adults and for subgroups defined by insurance status and poverty level. NHIS collects information about the health and health care of the civilian noninstitutionalized U.S.
Gindi are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Health Interview Statistics.
And in long-term care settings, PASS packaging helps prevent potential medication errors caused by interruptions and distractions during med pass. Undocumented immigrants are ineligible for coverage through either Medicaid or the Marketplace. This report also contributes to the body of literature on the potential burden of prescription drug costs among vulnerable populations including the uninsured and those who are poor (7,8). All estimates shown in this report meet the NCHS standard of reliability (relative standard error less than or equal to 30%). Adults who were poor, near poor, or uninsured were more likely to not take medication as prescribed to reduce their prescription drug costs. Interviews are conducted in respondents' homes, but follow-ups to complete interviews may be conducted over the telephone. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Adults aged 65 and over generally were less likely than adults aged 18a€“64 to use strategies to reduce their prescription drug costs. Note that NHIS asks respondents about their personal earnings and family income for the previous calendar year (2010). If patients do not take their medications as directed their conditions cannot be effectively treated and managed. Questions about strategies to reduce prescription drug cost are from the Sample Adult component.
Adults aged 65 and over with Medicare-only coverage were more likely than those with private or those with Medicare and Medicaid coverage to ask their doctor for a lower-cost medication to save money. In 2011, information was collected on a total of 33,014 persons aged 18 and over from the Sample Adult component of the survey. Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not significant. Differences in use of cost-saving strategies were found by insurance status for those aged 18a€“64.
Furthermore, this chart illustrates the magnitude of the problem at various stages of medication adherence (CMAG, 2006).    Medication Errors - Up to 40% of patients discharged from hospitals will experience a medication error. Privately insured adults aged 18a€“64 were more likely than those with Medicaid coverage to ask their doctors for a lower-cost medication, however they were less likely than those with Medicaid coverage to not take medication as prescribed.
The causes of medication errors is the result of fractionated information systems, insufficient patient education and understanding, and non-adherence. This report focused only on cost-related strategies used by adults to reduce their prescription medication costs. The Institute of Medicine and the American Medical Association have reported an alarming number of deaths attributed to medication errors and adverse drug events.Adverse Drug Events - Defined as any injury resulting from medical intervention related to a drug whose outcome is unexpected and unacceptable to the patient and health care provider.
There are other barriers to medication adherence including those not related to cost (9) that are not measured in NHIS. Pharmacy Solutions provides an additonal feature to effectively measure and monitor medication adherence. Our programs currently focus on Behavioral Health, Polypharmacy, Congestive Heart Failure, COPD, Diabetes, and Hypertension.  In acute care settings, the medication adherence process starts with the admitting medication reconciliation and continues through the hospital stay. Thus, this is a powerful program that can change the dynamics of patient health related outcomes and reduce total health care costs. Orange polyethylene-linedlight-resistant tubing hospira mednet manages infusion a smart pumps-dehp.
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