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32 Million Underinsured in U.S., Report Finds

A nurse checks a patient's blood pressure at the Remote Area Medical (RAM), healthcare clinic in Wise, Va., in 2008. The free weekend clinic, staffed by more than 1,400 volunteer dentists, doctors and medical personnel, is the largest of its kind in the nation and organizers expect more than 2,500 patients to turn out for the 2 1/2 day event. Residents of the area, most from the "coal counties" of Appalachia, come from one of the poorest and least educated areas in the United States. Most are underinsured or have no healthcare at all, and for many the annual RAM event is the only medical treatment they may get all year.John Moore / Getty Images file

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A new report finds that 32 million people were underinsured in the U.S. in 2012, meaning their health insurance didn’t do enough to cover their costs.

That makes for 80 million Americans who either have no health insurance at all, or who don’t have enough, the report finds.

It will be important to watch and see if the provisions of the Affordable Care Act cut into this number, the non-profit Commonwealth Fund said in issuing the report.

Those most likely to miss out will be people living in states that choose not to expand Medicaid, said the group, which advocates for health reform.

“This report demonstrates that the health reform law was accurately targeted toward the needs of the uninsured and underinsured," Commonwealth Fund senior vice president Cathy Schoen, who led the team writing the report, said in a statement. "However, if all states don’t expand Medicaid, millions will still go without health insurance and health care.”

The 2010 Affordable Care Act (ACA), popularly known as Obamacare, was designed to help get health insurance to the 16 percent of the U.S. population who did not have it, and to improve the insurance coverage for millions of others with less-than-comprehensive coverage.

It aims to do so by providing heavily subsidized private insurance via online exchanges, and by using federal dollars to underwrite a big expansion of the Medicaid health insurance plan for low-income people to more adults. But 20 states, all Republican-controlled, have said they won’t do it.

Health insurance can fall short in several different ways. Insurers can refuse to pay for covering treatments if people had the illness before they were covered. The ACA forbids them from doing this. Also now forbidden is the once widespread practice of “capping” coverage after a person has cost an insurer a certain amount. Insurance can also charge very high co-pays for treatments, doctor visits and hospital stays.

The report defines people as underinsured if they have health insurance but still spend 10 percent or more of their income on medical costs; 5 percent or more if they are low-income.

“It will be critical to monitor the law’s impact to determine whether it’s achieving its goals of ensuring that these millions of Americans gain access to affordable, stable, comprehensive coverage," said Commonwealth Fund president Dr. David Blumenthal.

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