IT IS NOW TIME TO EXTEND COVERAGE TO ALL

Project on the Consequences of Uninsurance: An Overview

Study Background
Institute of Medicine’s Committee on the Consequences of Uninsurance has completed a three-year study focusing on what being uninsured means for individuals, families, communities, and society as a whole. When the committee began its work in 2000, about 40 million Americans under the age of 65 lacked any health insurance, despite a very strong economy over the previous decade. Since then, another 3 million individuals have joined the rolls of the uninsured. Without major public policy reforms, the number of uninsured people across the nation will continue to rise in the years ahead.

Previous Reports
To inform the long-standing and critically important debate on extending coverage to all Americans, the committee comprehensively studied the issue and released six reports between October 2001 and January 2004. These reports present a conceptual framework and consolidated evidence base with which to assess the implications of our nation’s policies regarding health insurance, which leave one out of every seven Americans without coverage. Based on its first five reports, the committee concluded that:

• The number of uninsured individuals under age 65 is large, growing, and has persisted even during periods of strong economic growth.
• Uninsured children and adults do not receive the care they need. Consequently, they suffer from poorer health and development, and are more likely to die prematurely than those with coverage; 18,000 unnecessary deaths are attributable to lack of health coverage every year.
• Even one uninsured person in a family can put the financial stability and health of the whole family at risk.
• A community’s high rate of uninsurance can adversely affect the overall health status of the community, the financial stability of its health care institutions and providers, and the access of its residents to certain services, such as emergency departments and trauma centers.
• The estimated value of healthy years of life gained by providing health insurance coverage to all is almost certainly greater than the costs that would be incurred by providing those without coverage the same level of services enjoyed by those who have insurance.[1]

Principles and Recommendations

The committee proposes a clear and compelling overall recommendation — by 2010 everyone in the United States should have health insurance — and urges the president and Congress to act immediately by establishing a firm and explicit plan to reach this goal. The committee envisions an approach that will promote better overall health for individuals, families, communities, and the nation by providing financial access for everyone to necessary, appropriate, and effective health services.

In its sixth and final report, Insuring America’s Health: Principles and Recommendations, the committee offers a set of guiding principles, based on its extensive research, for analyzing the pros and cons of different approaches to providing coverage. The principles for guiding the debate and evaluating various strategies are:

• Health care coverage should be universal.
• Health care coverage should be continuous.
• Health care coverage should be affordable to individuals and families.
• The health insurance strategy should be affordable and sustainable for society.
• Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

Although all the principles are necessary, the first is the most basic and important. The principles are intentionally general, which allows them to be applied in more specific operational and political processes. A fact sheet on each of these principles and a checklist of questions based on the principles are included in this packet of information.

While the committee does not advocate a specific proposal to eliminate uninsurance, we believe that further efforts to gradually expand coverage through incremental reforms — the policy approach that has long been pursued — is unlikely to do the job. Extending health insurance coverage to all requires substantial reform of health care financing, initiated at the federal level, though not necessarily administered federally or standardized across the states. The committee’s principles are intended to contribute to the public debate about insurance, inform choices about policy alternatives, and, we hope, promote major reform of federal policy.  

Reports of the Committee on the Consequences of Uninsurance

Copies of the committee’s reports are available for sale from the National Academies Press; call 1-800-624-6242 or 202-334-3313 in the Washington metropolitan area, or visit www.iom.edu/uninsured for access to the reports, report briefs in English and Spanish, other related information, and links to other useful Web sites.

Insuring America’s Health: Principles and Recommendations, January 2004
Hidden Costs, Value Lost, June 2003
A Shared Destiny: Community Effects of Uninsurance, March 2003
Health Insurance Is a Family Matter, September 2002
Care Without Coverage: Too Little, Too Late, May 2002
Coverage Matters: Insurance and Health Care, October 2001

Media Contact: Christine Stencel, Office of News and Public Information, The National Academies; tel. 202-334-2138 or e-mail news@nas.edu

[1] An “insured” level of services reflects the current average use of services under Medicaid or private health insurance for those under age 65.