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Problems with unaffordable medical bills and medical debt are not limited to those who lack health insurance coverage. More than four in ten insured non-elderly adults had medical bill problems in 2007, and nearly three in ten had medical debt.  

Through research and engagement projects, The Access Project has worked to identify problems in the private insurance market that cause people to have unaffordable medical bills and medical debt, as well as groups that are particularly affected by these problems. It has joined with organizations and individuals to advocate for reforms to help deal with these problems.

Small employers project

In recent years, health insurance premiums have risen at rates far greater than inflation or wage increases. The problem is especially severe for small businesses, which are charged higher premiums for less comprehensive benefits than larger firms. As a result, fewer small firms are offering health insurance and fewer workers in small firms are taking up coverage when offered. Small firms that continue to provide insurance benefits may find that the costs place them at a serious economic disadvantage, or may feel forced to water down coverage in order to keep premiums affordable.

The Access Project has joined with county officials in Cedar Rapids, Iowa and in six rural California counties to survey small employers about their experiences trying to obtain health insurance for their employees. The survey also asked about small employers’ attitudes about health care system reforms that could alleviate their problems. Our county partners will use the survey results to engage small employers in their communities in health care discussions and initiatives. The project is based on the belief that the voices of many small business people have not been heard in our ongoing health care debates, and that their support is essential as efforts to reform our health care system go forward.

In 2009, The Access Project completed a survey of small employers in six rural California counties. The survey asked about their experiences trying to obtain health insurance and their attitudes toward proposals to make insurance more affordable. Staff recently presented the results of the survey at an Economic Summit in Del Norte County and encouraged small employers to get involved in health reform discussions.

Read more | View the Presentation | Article on the Summit

In the summer of 2007, The Access Project conducted an online survey of small employers in the Cedar Rapids/Linn County area. The survey asked questions about whether the companies offered health insurance to their employees and about employers' experiences purchasing and using insurance products. Findings from the survey are captured in the report below.

The Linn County, Iowa Small Employers Health Insurance Survey Results

Student health insurance

Through its research and work with students across the country, The Access Project has revealed that health insurance sold to students through institutions of higher learning is often grossly inadequate. Many student insurance plans have limited benefits, routinely deny claims that should have been paid, and offer misleading or inaccurate information to their subscribers.

In Massachusetts , The Access Project has submitted testimony to state agencies calling for improvement in these plans. It has also worked with the Student Health Organizing Coalition, a group of current and former university students who are organizing to improve student health insurance.

We have also written a report describing the Qualifying Student Health Insurance Program (QSHIP) which was created under the 1988 Universal Health Care Law signed by Governor Dukakis. The program requires Massachusetts students enrolled at least three-quarters time in an institution of higher learning to have health insurance. This report examines the quality of the QSHIP health plans; assesses the effectiveness of the first Massachusetts “individual mandate” at providing quality, comprehensive health insurance protections for students; and draws lessons that may be relevant to the implementation of the Commonwealth’s new health reform law, Chapter 58.

Not Making the Grade: Lessons Learned from the Massachusetts Student Health Insurance Mandate

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Underinsurance

The Access Project has not only documented the existence of underinsurance and inadequate insurance, but has conducted research to identify those elements of health insurance coverage that are most likely to leave people in financial jeopardy when they get sick.

From this research, we have written a report that describes how private insurance products fail to protect people from financial hardship and guarantee access to care when they become ill or injured. The Illusion of Coverage discusses insurance characteristics and processes that cause medical debt, people's lack of meaningful choices when purchasing health plans, and the consequences of medical debt caused by inadequate coverage. It also provides recommendations on how to provide people access to comprehensive and affordable insurance products.

The Illusion of Coverage

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Publications

Private Insurance Publications