The latest government statistics estimate that 47 millionAmericans do not have health insurance coverage. According to theKaiser Family Foundation, 54 percent of those Americans are inworking families. These are the working uninsured and they areoften in part-time and hourly jobs where they do not have access toa major medical plan through their employer or spouse.

Many companies are turning to limited-benefit health plans toprovide affordable health insurance to these working uninsured.Limited-benefit plans are typically 100 percent employee paid andcan be offered at no cost to the employer. Premiums for such a planoften start at one or two hours' pay per week, making access tohealth insurance a reality for part-time employee making $8 to $12per hour. The characteristics of risk assessment for the workinguninsured are completely different from the population that hasaccess to traditional major medical coverage. For underwriters itis important to identify these risks for the best classificationpossible.

A Matter of Priority

The health insurance industry often makes an incorrectassumption that everyone knows the importance of healthy living andthe consequences of poor lifestyle choices. This may be true forthose with traditional major coverage who have had access to thehealth-care system. However, for the working uninsured, theirability to access health care even if their employer offers alimited-benefit plan often ends up being a matter of priority.

CIGNA Market Research completed in 2008 found that 82 percent ofthe working uninsured felt that quality health insurance was tooexpensive. More than half of the respondents who felt this way hada household income of $25,000 or below. This same study found that71 percent of the working uninsured often skipped routine doctorvisits because of the cost. This situation obviously leads to anincrease of risk classification, even though 61 percent of thepopulation admits that they frequently worry that an accident orillness could cause major financial trouble.

The priority to enroll in health insurance is not as high forthe working uninsured. It is key to remember that unlike salariedor more highly compensated employees with traditional major medicalcoverage, many of the working uninsured are in industries such asrestaurant, retail and hospitality and are only making $8 to $12per hour. This income range means that immediate financialobligations are a higher priority than “optional” expenses likehealth insurance. CIGNA research found that health insurance iseighth on the list of financial priorities among the workinguninsured, ranking behind rent/mortgage, groceries, utilities, gas,car insurance and vehicle maintenance.

This information tell underwriters that the financial prioritiesof the working uninsured –putting health insurance far down thelist — can impact their ability to receive regular health care thatcould help them take the steps to lead a healthy life and avoidcatastrophic illnesses in the future.

A Chronic Characteristic

The working uninsured population is often painted as young,active and indifferent to medical care. However, a recent studypublished in the Annals of Internal Medicine found that the U.S.working-age population who suffer from chronic health conditions donot have insurance coverage and have less access to health carecompared to their insured counterparts.

Using data from the National Health and Nutritional ExaminationSurvey, the study estimated that 11.4 million working-age uninsuredhave been diagnosed with a chronic disease. These illnesses includeasthma, previous cancer, cardiovascular disease, diabetes,hypertension and obstructive lung disease. The study did not coverthose with multiple chronic illnesses, but did find that those whowere chronically ill but not insured were more than three timesmore likely not to have consulted a health professional — 22.6percent against 6.2 percent. They were also more than four timesmore likely not to have had a regular site for medical care in thepast 12 months, compared to those with insurance coverage — 26.1percent against 6.2 percent. Finally, they were also much morelikely to use an emergency room as a standard place of medical care— 7.1 percent against 1.1 percent.

With these findings it is fair to conclude that many of theworking uninsured may already suffer from a chronic condition thathas not been diagnosed.

Learning the Lifestyle

A complete comprehension of the working uninsured's lifestyle isvital for the most accurate risk classification rating.

Due to occupations in the service and hospitality industries,the working uninsureds often endure non-traditional work schedulesduring the evenings and weekends. Studies have shown that workingthese shifts leads to poor diet, obesity issues and diabetes. A2009 study by Harvard/Brigham and Women's Hospital researcher FrankA.J.L. Scheer has found that the risky behaviors of working againstthe natural body clock, eating meals immediately before bed, andlack of time to prepare meals contribute directly to these healthissues.

This is added to the fact that the working uninsureds often donot have access to the disposable income that covers the high costof eating healthy. Fresh fruits and vegetables, whole grains, leanmeats, fresh fish and low-fat dairy products are often replaced byfast-food staples such as hamburgers, tacos, fried foods andmilkshakes. These food items are cheaper on people's wallets in theshort-term but make them long-term underwriting risks.

The preventive services offered by a quality limited-benefithealth plan lowers risk once the working uninsured become regularhealth-care customers. However, during the risk assessment it isimportant to remember the variety of health issues that may havenot been addressed with preventive care. Tobacco cessation,information about alcohol use, chiropractic issues, and hearing andvision exams all probably have been neglected — meaning more risk.Female members of the working uninsured are risks due to a lack ofannual mammogram and pap smear exams. And because of regularfinancial concerns, all members of the working uninsured aresubject to poorly managed stress.

The number of employees at risk of becoming part of the workinguninsured will continue to expand as businesses align theemployment status of their employees to new economic realities. Ascoverage options for the working uninsured receive more attentionfrom the public and private sectors, all risk factors must be takeninto consideration in order to create an accurate plan.

Curt A. Wieden is vice president of product and marketing forCIGNA Voluntary, headquartered in Phoenix. He may be reached at800-258-9260 or [email protected],www.cignavoluntary.com.