Classifying Risk For The Working Uninsured

The working uninsured population is often painted as young, active and indifferent to medical care. A recent study published in the Annals of Internal Medicine, however, found that the U.S. working age population who do not have insurance coverage often suffer from chronic health conditions yet have less access to health care than their insured counterparts.

Using data from the National Health and Nutritional Examination Survey conducted by the Centers for Disease Control and Prevention, the study estimated that 11.4 million working age uninsured have been diagnosed with a chronic disease. These illnesses include asthma, previous cancer, cardiovascular disease, diabetes, hypertension and obstructive lung disease. The study did not cover those with multiple chronic illnesses but did find that those who were chronically ill but not insured were more than three times more likely not to have consulted a health professional–22.6% against 6.2% of the insured population. They were also more than four times more likely not to have had a regular site for medical care in the past 12 months, compared to those with insurance coverage–26.1% against 6.2%. Finally, they were also a lot more likely to use an emergency room as a standard place of medical care–7.1% against 1.1%.

With these findings, it is fair to conclude that many of the working uninsured may already suffer from a chronic condition that has not been diagnosed.

Learning the lifestyle

A complete understanding of the working uninsured’s lifestyle is vital for the most accurate risk rating.

Working uninsured in the service and hospitality industries often endure nontraditional work schedules during the evenings, weekends and third shift. Studies have shown that working these shifts leads to poor diet, obesity and diabetes. A 2009 study by Harvard/Brigham and Women’s Hospital researcher Frank A.J.L. Scheer has found that the risky behaviors of working against the natural body clock, eating meals immediately before bed and lacking time to prepare meals contribute directly to these health issues.

This is added to the fact that the working uninsured often do not have the disposable income needed to cover the high cost of eating healthy. Fresh fruits and vegetables, whole grains, lean meats, fresh fish and low-fat dairy products are often replaced in their diet by fast-food staples such as hamburgers, tacos, fried foods and milkshakes. These food items are cheaper on their wallets in the short-term but make them long-term underwriting risks.

The preventive services offered by a quality limited-benefit health plan lowers risk once the working uninsured become regular health care customers. During the risk assessment, however, it is important to remember the variety of health issues that preventive care may not have addressed. Tobacco cessation, information about alcohol use, chiropractic issues as well as hearing and vision exams all probably have been neglected–meaning more risk.

Female members of the working uninsured are at relatively higher risk due to a lack of annual mammogram and pap smear exams. And because of regular financial concerns, all members of the working uninsured are subject to poorly managed stress.

The number of employees at risk of becoming part of the working uninsured will continue to expand as businesses align the benefits of their employees to new economic realities. As the working uninsured receive more attention from the public and private sector, companies underwriting their plans must identify all of the risk factors to create an accurately priced plan.

Curt A. Wieden is vice president of product and marketing for CIGNA Voluntary, Phoenix, a division of CIGNA Corp., Philadelphia. He can be reached at [email protected].