Measures of Underinsurance: Kansas as an Example of State-Level Estimates

In recent years, with the erosion of employer-sponsored health insurance, increased cost sharing by employees in the form of deductibles and co-payments, and the carving out of heretofore offered benefits, many people with health insurance are finding that insurance to be inadequate. These people are not uninsured but instead form the emergent class of people who are underinsured. Whereas a person is either insured or uninsured at a given point of time, characterizing a person as underinsured is not so simple. People can be more or less underinsured, and may be underinsured either because of excessive healthcare costs, or because some needed benefit is not covered by the person's health insurance. Finding metrics that appropriately capture these dimensions of underinsurance has proven challenging, especially when one is interested in state-level estimates. Nevertheless, because many of the remedies for inadequate health insurance coverage require crafting effective and equitable state policies, finding metrics for state-level estimates is important. Using Kansas as an example of what can (and cannot) be estimated, we compare and contrast various extant state-level data sources (e.g., Behavior Risk Factor Surveillance System, the 2001 Kansas HealthWave Survey, the 2001 Kansas Health Insurance Study) to determine which dimensions of underinsurance can be quantified. To assess Kansas relative to the nation as a whole, we compare these estimates to commensurable U.S. estimates from national data sources (e.g., National Health Insurance Survey). We conclude with recommendations about what kind of data collection remains to be done to ensure sound policy creation.