There has been much talk in recent weeks about the ability of the Affordable Care Act (ACA) not only to reduce uninsurance, but also underinsurance, which is the state of being inadequately insured, such that medical expenses remain a threat to one’s financial health.

The health care reform that Massachusetts launched in 2006 to no small degree provided the model on which the ACA is based.  Therefore, the current state of affairs in the Commonwealth provides a good basis for predicting the impact of the ACA.  Such an evaluation, unfortunately, gives grounds for pessimism on the issue of underinsurance.

A post on the Health Affairs blog last week reviews how high health care costs remain a serious problem for many insured individuals in Massachusetts.  Among the facts and figures:

-One third of adults with insurance coverage reported problems with health care costs in 2012;

-Four in ten insured low-income adults had difficulty paying for health care expenses;

-Insured adults reported foregoing health care, cutting back on other spending, or incurring debt to pay for health care.

Real universal health care is not only about expanding “coverage”: it means eliminating both uninsurance and underinsurance, such that sickness no longer entails financial strain or distress.  The “mandate model” of reform, unfortunately, doesn’t seem to reach that important standard.