Underinsured in America

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A new study in Health Affairs takes up an issue often neglected in debates over health care, but quite important: namely, the underinsured. These people have coverage, but it’s usually inadequate, leaving them vulnerable to high out-of-pocket costs and often forcing them to forego essential care. About 12 percent of adults, some 16 million, fell into this category in 2003, which can be tacked onto the estimated 45 million without insurance at all. Most of the underinsured were either minorities, had low incomes, or were sick.

The other big story here is that the vast numbers of underinsured are the result of an increasing trend in America. Employers, wracked with health care costs, are responding by pushing more and more of the financial burden for coverage onto the workers themselves, whether that includes higher deductibles, patient cost sharing, or restricting benefits. As a result, many workers are left without adequate coverage, and end up seeking out less care in the end. (Cost-sharing, almost by definition, hits the poor and the sick the hardest.)

It’s doubtful that this trend can be reversed, and at any rate, it probably shouldn’t be. Employers were never meant to be in the business of providing health care, and that goes double in an age where workers switch jobs frequently and firms need to be competitive in the global economy. Eventually, the government will have to take over the business of managing care. That’s inevitable. The problem is that unless the transition period is well-managed—which is certainly not the case right now—then we’re in for a long period of time where companies are slowly and steadily loading the costs onto the backs of their workers and more and more employees become unable to afford adequate care. Eventually it will all hit a crisis point and voters will demand some sort of national health care system. But who knows when that will be? The interim period, meanwhile, will be devastating.

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WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

If you can, please support the reporting you get from Mother Jones—that exists to make a difference, not a profit—with a donation of any amount today. We need more donations than normal to come in from this specific blurb to help close our funding gap before it gets any bigger.

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