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“These findings call attention to the continuing instability and insecurity of health insurance in our country,” says Pamela Farley Short, professor of health policy and administration at Penn State. “With more than a third of all Americans under age 65 being uninsured at some point in a four-year period, it’s easy to see that the problem of being uninsured is a big one that affects lots of people.”

For their study, published in Medical Care Research and Review, researchers used data from the US Census Bureau’s Survey of Income and Program Participation, which collects information from the same individuals every four months over a four-year period. The team examined changes in insurance coverage among people ages 4 to 64 from 2004 to 2007, which is the most recent period for which four-year data are available.

The researchers found that, of the 89 million people who were uninsured during the period from 2004 to 2007, 12 million were continually uninsured; 11 million gained coverage at some point; 11.5 lost coverage; 14 million experienced a single gap in coverage; and 6 million had a temporary spell of coverage, but were otherwise uninsured. In addition, 23 million people lost health insurance more than once during the four-year period.

“There is clear evidence that people who are uninsured use fewer services than people who have insurance; they postpone prevention and ignore serious problems because they don’t feel they can afford the care,” Short says. “As a result, some even die for lack of insurance.”

But not only do people with gaps in their coverage suffer; those who remain insured and pay premiums suffer as well.

“When people get caught without health insurance, hospitals and emergency rooms are still required to care for them,” Short says. “Someone has to pay for those services.”

Low-income people are particularly susceptible to periodic losses of health insurance coverage, according to the survey, that also shows that a little over 64 percent of adults and nearly 60 percent of children who are below 200 percent of the federal poverty level—equivalent to $46,100/year for a family of four—were uninsured for at least one month during the four-year period.

“Even though low-income people are disproportionately affected by gaps in health insurance, none of us is really safe,” Short says. “Any one of us could be afflicted with a serious health problem that could cause us to lose our jobs and our access to employment-based insurance, which is how most of us get insurance.”

In addition to losing or changing jobs, gaps in insurance coverage can occur when people divorce and when children age out of their parents’ plans or public insurance programs.

“We all have a stake in this problem of providing everyone with continuing access to affordable insurance,” Short says. “Promoting stability and minimizing uninsured gaps should be high priorities as federal and state officials proceed with the implementation of national health care reforms.”

Researchers from Harvard University contributed to the study that was supported by the Commonwealth Fund.

More news from Penn State: http://live.psu.edu/