(CBS) - Nearly 32 million Americans younger than 65 were underinsured in 2012 -- the year before several major provisions of the Affordable Care Act went into effect -- according to a new report from the Commonwealth Fund, a private health policy foundation. In that year, 79 million Americans were either underinsured or uninsured. More than half were from low-income households, while 20 percent were classified as middle income.
According to the report, a person who is underinsured lives in a household with insurance but still spends 10 percent or more of their income on medical care, excluding monthly premiums. Americans living 200 percent below poverty line who spend 5 percent of their income or more on health care also are, by definition, underinsured. Medical expenses include copayments to see a doctor or specialist, prescription medications, as well as tests and procedures not covered under a plan.
The report, generated with data from U.S. Census Bureau's Current Population Surveys for 2012 and 2013, is the first to examine rates of underinsurance on a state-by-state level. Before the launch of some of the most significant reforms in the Affordable Care Act, the share of people who couldn't afford health care varied from 14 percent in Massachusetts and 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas.
"The vast majority of people struggling to afford health care are low- and middle- income, and exactly the people the Affordable Care Act was designed to help," lead author Cathy Schoen said in a written statement. "However, if all states don't expand Medicaid, millions will still go without health insurance and health care," added Schoen, who is also the senior vice president of the Commonwealth Fund.
Early provisions of the Obamacare rollout have lowered some out-of-pocket health care costs, such as the mandate to cover routine preventive care and one that bars denial of coverage due to preexisting health conditions.
The report, published less than a week before the Health Care Exchange's first open enrollment period ends, indicates President Barack Obama's goal to insure every American may be attainable in the coming years. Already since the start of the rollout the number of uninsured Americans declined by nearly 2 million between 2010 and 2012, according the report.
"To assess the impact of reforms will require monitoring affordability of care for the insured, as well as the number of people remaining uninsured," the authors write in the conclusion of the report. "Preventing more people from becoming underinsured will depend on state action, oversight of insurance plans offered, and the individual choices consumers make when selecting coverage."
© 2014 CBS Interactive Inc. All Rights Reserved.
Posted by Melissa Brunner