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Even With Insurance, Unemployed Have Worse Health Outcomes

By Steven Reinberg
HealthDay Reporter

TUESDAY, Jan. 24 (HealthDay News) -- People without jobs who have health insurance are less likely to get medical care or prescription drugs than people with jobs who have such coverage, U.S. health officials reported Tuesday.

During the depths of the recent recession, unemployment reached 9.6 percent, a level not seen since 1983. Because health insurance affects access to care and most people rely on getting insured through their employer, researchers wanted to look at the effect of unemployment and lower income on access to health care, according to the U.S. Centers for Disease Control and Prevention.

"Insurance without a job is a difficult position to be in," said report author Anne Driscoll, a senior fellow at the CDC's National Center for Health Statistics.

In the study, Driscoll and her colleague, Amy Bernstein, wanted to find out whether having private, public or no insurance mattered if you were employed or unemployed.

They found that private insurance, which experts think is the most comprehensive, was no guarantee of better health care.

"If you had private insurance but weren't employed, you had worse mental health, worse physical health and were less likely to get prescriptions you needed or care that you needed than if you had a job," Driscoll said.

Cost of care appears to be the overriding factor why having private insurance and no job was associated with lack of access to care, she said.

"Because you don't have a job, deductibles and co-payments are the reasons you can't use your insurance to the fullest. You're better having insurance than no insurance, but it's not a panacea. A job and insurance is the most advantageous category to be in, not just being insured," Driscoll said.

For their study, the authors used data from the 2009 and 2010 U.S. National Health Interview Survey and compared the health insurance status, health and access to health care of employed and unemployed adults aged 18 to 64.

Highlights of the report include:

  • 48 percent of unemployed adults had health insurance, compared with 81 percent of employed adults.
  • More of the unemployed had public insurance than those employed.
  • The unemployed had worse physical and mental health than the employed, whether they had insurance or not.
  • The insured unemployed were less likely to get medical care because of cost than the insured employed.
  • The insured unemployed were less likely to get prescription drugs because of cost than the insured employed.
  • The uninsured were less likely to get medical care and prescription drugs because of cost than people with public or private insurance, regardless of whether they had jobs or not.
  • The unemployed were more likely to be black, have less than a high school education and have an income below the poverty level.

Dr. Steffie Woolhandler, a visiting professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, doesn't hold out hope that health care reform will make things better for the unemployed.

"During the recession, the use of health care plummeted. We had a 19.5 percent drop in primary care in the United States," she said.

This study shows that even if people lost their jobs and held onto their insurance, they couldn't afford to use health care, Woolhandler said.

"That's a uniquely American issue because we have such high co-payments, deductibles and uncovered services that people can't afford to use care," she said.

Woolhandler noted that health care reform will help some people because the number of uninsured is expected to be cut by over half.

"While there will still be 23 million uninsured after health reform is fully implemented, it's a whole lot less than it would be otherwise," she said.

But, having health insurance will not mean that you can afford care if you lose your job, Woolhandler added.

"It will be a little worse after health reform, because the new policies that will be offered will be quite a bit skimpier than an employer policy is now. And there will be high co-pays, high deductibles. So even if you hang on to your insurance you likely won't be able to afford care," she said.

More information

For more on health insurance, visit the Commonwealth Fund.

SOURCES: Anne K. Driscoll, Dr.P.H., senior fellow, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; Steffie Woolhandler, M.D., M.P.H., visiting professor, medicine, Harvard Medical School, and co-founder, Physicians for a National Health Program; Jan. 24, 2012, Health and Access to Care Among Employed and Unemployed Adults: United States, 2009-2010

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