As health coverage expansion and its attendant costs are debated on the campaign trail and in Congress and state legislatures, two recent Health Affairs articles dealing with coverage issues – one on the rising number of “underinsured” Americans and the second on the state of the landmark Massachusetts reforms after their first year – have attracted a great deal of attention.

On Tuesday, Health Affairs published a new Commonwealth Fund study reporting that the number of underinsured adults — those with health insurance all year, but also very high medical expenses relative to their incomes — rose by 60 percent between 2003 and 2007, from 16 million to more than 25 million. Middle- and higher-income families were hit the hardest by the steep increase: underinsurance rates nearly tripled for those with incomes above 200 percent of the federal poverty level, which is an annual family income of $40,000 or higher.

The Commonwealth Fund study was reported on by news outlets including the NewsHour With Jim Lehrer, and the New York Times. In an editorial focusing on the study, the Times concluded:

Cutting health care costs and reducing the number of uninsured Americans are critical priorities for this country. But the health care debate needs a wider focus to also address the plight of the underinsured. Insurance plans that discourage needed care will only cause greater sickness and higher costs down the road.

On June 4, Health Affairs published research showing that, in the first year after Massachusetts implemented its landmark coverage expansion and health reforms, the uninsurance rate among adults in the state dropped by almost half, from 13 percent to 7.1 percent. That finding was contained in a study by the Urban Institute’s Sharon Long, which Health Affairs published along with a second study on the Massachusetts experience by researchers from Health Care For All in Boston.

Long’s study showed that access to care for low-income Massachusetts adults has increased, and the share of adults with high out-of-pocket health care costs and problems paying medical bills has dropped. Both Long and the Health Care For All paper noted that Massachusetts is facing challenges in connection with the reforms, such as higher than expected costs and strains on the state’s primary care workforce. Long’s paper was cited in outlets such as the Boston Globe and the Associated Press.

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