A new report released today by the Commonwealth Fund finds that in 2012 an estimated 84 million people did not have health insurance for the full year or were underinsured―and thus unprotected from high out-of-pocket medical costs. Based on the Fund’s 2012 Biennial Health Insurance Survey, the analysis also found that millions of U.S. adults are struggling to pay medical bills and avoiding timely health care for financial reasons. 
 
 For the first time, the Commonwealth Fund supplemented its national survey results with state-specific data for the nation’s four largest states: California, Florida, New York, and Texas. Let’s examine how residents in these states fared in 2012, compared with the national average, on key measures of insurance coverage and affordability of care. 
 
 Insurance coverage. Nearly half (46%) of adults ages 19 to 64 nationwide either had been uninsured for a time last year or were underinsured. In Florida and Texas, more than half (53% and 54%) of adults were either uninsured during the year or underinsured (Exhibit 1). Adults in these states were at greater risk of being uninsured or inadequately insured than California and New York adults (42% and 43%). In Texas, 40 percent of adults reported being uninsured for some time during the year, compared with 31 percent in California and New York. 
 
 Problems paying medical bills. Nationally, two of five (41%) adults, an estimated 75 million people, reported they had problems paying medical bills or were paying off medical debt over time (Exhibit 2). Nearly half (48%) of Floridians reported they had difficulty paying medical bills or were paying off accrued medical debt—the highest rate across the four states. This was 14 percentage points higher than the share of adults reporting these problems in California, where 34 percent had medical bill problems or debt―the lowest rate reported among these four states. 
 
 Cost-related problems getting needed health care. Cost is a substantial obstacle to Americans’ ability to secure timely health care. In the survey, two of five (43%) adults, or 80 million people, said they had not filled a prescription or pursued needed care because the cost of doing so was too high. As with medical bills or debt, Florida stood out for having the highest rates of forgoing care because of the cost, with fully half (51%) of adult residents saying they had not gotten care for that reason. Still, nearly half of adults in both New York (48%) and Florida (47%) pointed to financial reasons for avoiding health care. And while adults in California reported these problems at slightly lower rates, they fared no better than adults nationally. 
 
 Implications for health reform. The open enrollment period for the Affordable Care Act’s new insurance coverage options begins this October in all 50 states. People without health insurance, or those who are inadequately insured, will be able to visit a health insurance marketplace to find out if they are eligible for help. This includes new subsidies to cover the cost of a private health plan sold through the marketplace, available to people earning up to about $92,000 for a family of four, as well as a newly expanded Medicaid program for people with incomes up to about $31,000 for a family of four. States can run their own insurance marketplaces or choose a federally operated marketplace. California and New York elected to operate their own, while Florida and Texas selected federal marketplaces. 
 
 Last summer’s Supreme Court decision allowed states to decide whether they want to participate in the law’s Medicaid expansion, which is 100 percent federally financed in most states through 2016. So far, 20 states and the District of Columbia have announced that they will expand their programs, and at least five states are exploring alternative approaches to expanding their programs (Exhibit 3). About 25 states are either undecided or have decided not to participate in the expansion. Of the four states in the survey, California and New York elected to expand their Medicaid programs. Florida’s governor also decided to participate, though he met resistance from some state lawmakers. Texas’s governor declined to participate. 
 
 The consequences of state decisions to participate in the Medicaid expansion are significant. Whereas the federal government will operate insurance marketplaces in states that have chosen not to run their own, there is no full replacement program for residents of states that do not participate in the Medicaid expansion, since it was assumed when the law was written that all states would join. Thus, most of the poorest residents in states that do not expand Medicaid—those with incomes under $23,000 for a family of four—will continue to lack affordable insurance options. ||||| FICO introduced its new FICO Score 9 as a way to assess consumer collection information, bypassing paid collection agency accounts and differentiating between medical and non-medical collection agency accounts. 
 
 The latest product ensures that medical collections have a lower impact on the score, commensurate with the credit risk they represent. 
 
 As a result, median FICO scores for consumers whose only major black marks are unpaid medical debts are expected to increase by 25 points. 
 
 In addition, FICO says the update is more predictive of a consumer's likelihood to repay a debt than previous versions, capturing recent consumer behavior to give lenders better risk assessments across the credit lifecycle and all credit products. 
 
 But the new technology doesn’t come without scrutiny from its competitor VantageScore. 
 
 “FICO’s announcement appears to be a competitive response to the traction that VantageScore 3.0 has garnered amongst the largest lenders in the country, and changes to the new FICO model apparently try to remedy many lender and consumer challenges already addressed by VantageScore,” Barrett Burns, president and CEO of VantageScore Solutions. 
 
 “The real test of a model’s capability is how it performs on each lender’s unique portfolio, and we challenge every lender to test any model they are using, and any other models available to them, against VantageScore 3.0 to be sure they are employing the best model for their business strategy,” Burns added. 
 
 VantageScore came into fruition by the three national bureaus Experian, TransUnion and Equifax, in rebuttal to FICO. And the two have been in conflict since. 
 
 Back in March, VantageScore released VantageScore 3.0, which wields similar characteristics to FICO Score 9. 
 
 “The VantageScore 3.0 model provides risk managers a level of predictiveness that will allow them to confidently extend credit to tens of millions of consumers that were previously invisible to them so that those consumers have a greater chance to access mainstream credit, which is one of our principle goals,” Burns said. 
 
 In response, Anthony Sprauve, senior consumer credit specialist with FICO, said, "Vantage Score 3.0 only addresses paid collections, which only account for 10% of collections reported to the three national credit bureaus. What FICO announced today is a new refined treatment of unpaid collections – medical and non-medical – that differentiates unpaid medical from unpaid non-medical collection agency accounts." 
 
 "This ensures that unpaid medical collections have a lower impact on the FICO Score, commensurate with the credit risk they represent. These enhancements result in greater precision," he continued. ||||| NEW YORK (CNNMoney) 
 
 If you have loads of medical debt in collections, you could see your credit score go up soon. 
 
 FICO, the nation's top credit score provider, is introducing a new scoring model this fall where medical debt in collections will have less of an impact on a consumer's credit score than it currently does. 
 
 The median FICO score for people who have only unpaid medical debt on their report will jump by about 25 points, the company said Thursday. 
 
 Related: 1 in 3 adults have debt in collections 
 
 "This underscores that medical obligations are very different than any other kind of obligations because consumers don't choose to incur hospital debt -- it's a very different type of risk posed by a consumer when they default on that type of debt," said John Ulzheimer, expert at CreditSesame.com. 
 
 The change means that many consumers drowning in medical bills they can't pay will look less risky to lenders -- and will likely be able to qualify for better rates and deals. 
 
 But if you have other kinds of unpaid debt in addition to medical debt, you will likely see a smaller increase in your score -- if any at all. 
 
 Related: Credit card issuers urged to provide free credit scores 
 
 "It's going to be either neutral or helpful to everyone," said Ulzheimer. 
 
 Another change to the way it calculates scores: FICO will begin ignoring debt in collections that has been completely paid off or settled. Currently, debts that go into collections, even if they are paid off, are factored into all credit scores for up to seven years. 
 
 This is a move VantageScore, the scoring model created by credit bureaus Experian (EXPGF), Equifax (EFX) and TransUnion -- announced last year. ||||| A change in how the most widely used credit score in the U.S. is tallied will likely make it easier for tens of millions of Americans to get loans. 
 
 Fair Isaac Corp. said Thursday that it will stop including in its FICO credit-score calculations any record of a consumer failing to pay a bill if the bill has been paid or settled with a collection agency. The San Jose, Calif., company also will give less weight to unpaid medical bills...
– A modification to how one of the most common credit scores is calculated will mean better credit ratings for many Americans, reports the Wall Street Journal. Fair Isaac Corp. said yesterday that it won't place as much emphasis on medical debt when calculating consumers' FICO scores and will turn a blind eye to other debts that have been paid or settled through a collection agency. The new scoring system, which will be in place this fall, follows negotiations with the Consumer Financial Protection Bureau on ways to boost consumer lending. According to a Commonwealth Fund report cited in the Journal, 41% of US adults had a hard time coming up with funds to pay medical bills in 2012. Those who only have medical debt on their credit report could see an instant 25-point jump in their FICO score, according to CNN. The changes also mean that people who pay off their debts in collections won't be stuck with a seven-year black mark on their report like they have been. VantageScore—which manages the popular scoring model created by the Experian, TransUnion, and Equifax credit bureaus—says FICO's move is "a competitive response" to similar score-boosting changes it made last year, notes Housing Wire.