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When Boomers Go Bare

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Trying to get by without health coverage could increase the risk that about 200 relatively high-income American baby boomers will die this year.

That estimate is based on figures in a new study that suggests that U.S. residents ages 45 to 64 who lacked health coverage in 2006 suffered about 16,000 excess deaths.

If those figures are correct, they mean lack of health coverage may have contributed to the deaths in 2006 of about 1 in every 700 of the 11 million Americans ages 45 to 64 who were uninsured that year.

By way of comparison, motor vehicle accidents kill about 1 in every 6,200 Americans of all ages each year, according to the National Safety Council, Washington.

Stan Dorn, a senior research associate at the Urban Institute, Washington prepared the study. He came up with his figures by feeding recent census data into an equation that the Institute of Medicine, Washington, developed in 2002 to gauge the effects of uninsurance on mortality.

The estimates in the new paper “should be viewed as reasonable indicators of the general magnitude of excess mortality that results from lack of insurance, not as precise ‘body counts,’” Dorn writes. “The true number of deaths resulting from uninsurance may be somewhat higher or lower than the estimates in this paper, but that number is surely significant.”

Although Dorn did not include a boomer category in his paper, he did break out figures for Americans ages 45 to 54 and for Americans ages 55 to 64.

The developers of the IOM equation Dorn used started by relying on the observation that mortality is about 25% higher among uninsured Americans than among uninsured America. Some researchers have suggested that factors such as smoking and alcoholism among uninsured people may account for the mortality gap, but other researchers have found that a link between insurance status and mortality risk remains even after researchers control for a wide variety of variables, Dorn writes.

Health insurers and producers often talk about the role of the products they sell in improving Americans’ well being, but the numbers in the Dorn study helped back up the anecdotes with figures.

Tim McTavish, president of InsureMe Inc., Englewood, Colo., a Web-based insurance quote service, says he has been convinced all along that health insurance saves lives.

“We can’t let Americans think they can’t afford health insurance, or that they can get by without it,” McTavish says. “One of the reasons we love coming to work is we love helping these people get insured.”

Janet Trautwein, a former health insurance agent who is CEO of the National Association of Health Underwriters, Arlington, Va., says NAHU members are pleased to be able to help protect boomers with health insurance but are troubled that uninsurance rates remain so high. “One of our top priorities is to get people insured.”

Dorn does not break down the excess mortality rate for uninsured Americans by income in his paper.

Census figures show that about 729,000 U.S. residents with annual household incomes over $50,000 lacked health coverage in 2006, up 8.6% from the total for 2005.

More than a fifth of uninsured Americans under age 65 are boomers.

If one-fifth of the 729,000 uninsured U.S. residents with household incomes over $50,000 are boomers, then there might be about 140,000 uninsured boomers in that income bracket.

If uninsurance contributes to the deaths of 1 in 700 of those 140,000 relatively high-income boomers, then that could translate into about 200 in extra deaths.

Another way to come up with that estimate is to note that about 1.6% of uninsured Americans have household incomes over $50,000. Multiplying 1.6% — 0.016–times the 16,000 excess deaths that occurred among uninsured Americans ages 45 to 64 in 2006 produces a figure of about 200 deaths involving Americans ages 45 to 64 with incomes over $50,000.

One complicating factor is that, in some states on the East Coast and West Coast, a $50,000 household income is a fairly modest income. In many of those states, benefits mandates and restrictions on underwriting have pushed up coverage prices, according to health insurance industry groups.

NAHU has worked with other groups, such as America’s Health Insurance Plans, Washington, to tell state lawmakers that imposing too many requirements on health insurers could backfire, by making health insurance look too expensive to boomers and others who, in theory, should be able to afford coverage.

“I ask, ‘What if we were not allowed to purchase a no-frills dishwasher?’” Trautwein says.

In some cases, high-income individuals without employer-sponsored health coverage assume they can use their savings to self-insure, but “they underestimate the cost of getting the care they need should they become ill,” Trautwein says.

Massachusetts has tried to overcome that problem by requiring high-income and moderate-income residents without group coverage to buy private individual coverage.

At this point, NAHU still believes people have the right to choose whether to be insured, Trautwein says.


Kicker: Mortality


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