Absence of Health Insurance Coverage Costs $1.47 Billion in Maryland

Expenditures for the uninsured in Maryland totaled $1.47 billion in FY2002, according to an analysis conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The sum equates to $2,371 per individual without health insurance—paid for by state and federal funds, private insurance companies, physicians, charities and the uninsured themselves. The results of the study are published in the February 2007 edition of the Journal of Health Care for the Poor and Underserved.

“The lack of health insurance coverage carries serious financial consequences, both for individuals and Maryland as a whole. Our study provides detailed estimates of the magnitude of the costs of having an uninsured population,” said Hugh Waters, PhD, a health economist in the Bloomberg School’s Department of International Health and lead author of the study. “Our results highlight the important implications for policies to expand insurance coverage. Many of the costs of medical services that would be consumed by those newly-insured under an expansion are already paid for, either by the uninsured themselves or by others.”

The $1.47 billion figure represents direct expenditures by and for the uninsured in FY2002, and does not include losses to individuals in terms of decreased health status and increased uncertainty. Of the $1.47 billion, $438 million was spent directly by uninsured individuals as out-of-pocket health care expenditures. According to the study, the health system—including public and private health care payers, philanthropy and private physicians—spent $1.08 billion on the uninsured. Public health programs accounted for $462 million of this amount. Uncompensated hospital care accounted for $227 million, which the researchers said was a conservative estimate of the percentage of charity care that goes to uninsured patients rather than insured ones and bad debt reported by hospitals.

The state government paid the largest share of expenditures, spending $334 million on the uninsured in FY2002, of which $311 million went to public health programs that provided services for uninsured individuals. The state also contributed $20 million for uninsured hospital patients though hospital payment rates, and in funds paid to Federally Qualified Health Centers (FQHCs) and school-based health programs. The federal government paid $139 million for the uninsured through the hospital payment system, and also contributed $138 million through public health programs and FQHCs. Local governments directly contributed $10 million.

Private payers (private insurance, private physicians and philanthropy) contributed $318 million in direct expenditures for the uninsured. Private insurance companies paid $95 million for the uninsured through hospital rates under Maryland’s all-payer system, an amount reflected in higher insurance premiums for privately insured individuals. In addition, private physicians contributed an estimated $211 million in charity care, which is uncompensated care provided to uninsured individuals. Private philanthropic spending accounted for an additional $12 million.

For the study, the research team analyzed data related to the payment of health care for uninsured patients. They reviewed records on uncompensated hospital care, public health care subsidies, ambulatory services, philanthropic spending and expenditures by uninsured individuals. The data covered expenditures from July 2001 to June 2002.

“The cost of non-insurance in Maryland” was written by Hugh Waters, MS, PhD; Laura Steinhardt, MPH; Thomas R. Oliver, PhD; Alice Burton, MHS; and Susan Milner, MPH.

The study was completed under a grant from the Health Resources and Services Administration (HRSA) and in conjunction with the Maryland Department of Health and Mental Hygiene.