The number of US adults underinsured for health care jumped by a “startling” 60 per cent between 2003 and 2007, up from 16m to more than 25m, a leading health research foundation reported on Monday.

Together with those who have no health insurance, or who go without health cover for part of the year, 75m people, or 42 per cent of the adult population, were either uninsured or underinsured last year, the Commonwealth Fund reported.

Karen Davis, the fund’s president, said the figures showed the urgent need for health-care reform. Next year – following a presidential election in which health reform is expected to play a significant role – offered a “historic opportunity” to tackle the issue, she added.

The big rise in the numbers underinsured follows huge increases in insurance premiums in recent years – up 91 per cent since 2000 on average, compared with a 24 per cent increase in wages, according to the fund.

Employers want workers to pay a bigger share of the first part of health bills before cover kicks in – so-called deductibles – while raising co-payments or restricting core benefits such as prescription costs.

Small firms have found themselves forced to introduce higher deductibles in order to afford coverage, with the average of such payments tripling between 2000 and 2007. Deductibles of $1,000 and even $2,500 are now not uncommon.

The fund defines someone as underinsured when all out-of-pocket health expenses account for more than 10 per cent of income, or 5 per cent if an individual or family has an income below twice the poverty line – about $40,000 for a family.

It said the survey showed the problem was reaching well into middle-income groups, with more than 10 per cent of those earning between $20,000 and $60,000 a year affected.

“Premiums are up, but people are buying less protection”, as higher co-payments and limits on benefits take effect, said Cathy Schoen, a senior vice-president at the fund. “Today you can have health insurance and still go bankrupt if you get sick.”

The survey found that the underinsured faced similar problems to the uninsured, with 45 per cent of the former group reporting difficulty paying bills, or extending credit to do so. Fifty-three per cent reported not filling prescriptions, or skipping tests or treatments, or not visiting the doctor.

Among the uninsured, the percentage in these categories was 51 per cent and 68 per cent respectively.

“The US needs to move in new directions,” said Ms Davis. Middle and low-income families were struggling, and “shifting costs to patients is not an equitable or effective solution to rising costs”.

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