The Problem of the Uninsured In the United States

According to the latest Census Bureau report, there were more than forty one million uninsured Americans in the year 2001. Eight out of 10 were in working families. In most cases, the main earners in these families either had jobs that offered no health coverage or their premiums were unaffordable.

Because uninsured Americans cannot afford needed medical care, they live sicker and die younger than Americans with health coverage. For example: Uninsured women who develop breast cancer are twice as likely to die than insured women with the same diagnosis. Uninsured men are nearly twice as likely to be diagnosed at a late stage of colon cancer than insured men. Uninsured children who need medical or surgical care are four times more likely to go without care than insured children with the same needs. Uninsured children are almost five times more likely to be unable to receive needed dental care Uninsured children are four-and-one-half times more likely to do without needed prescription medicines or eyeglasses Uninsured children are more than one-and-one-half times more likely to be missing some or all of their immunizations. The number of uninsured Americans is rising for several reasons:First, the economy has slowed and more people are unemployed and without health coverage. Second, health care costs are rising at double-digit annual rates, making health coverage increasingly unaffordable for employers as well as individual consumers Third, as states experience fiscal shortfalls, they are cutting back on public health coverage programs, such as Medicaid, causing some low-income families to lose health coverage. Given these trends, the problem of the uninsured promises to grow worse, not better, in the coming years.

A June 2003 supplement of Medical Care Research and Review presents a compelling case that health insurance does lead to improved health and better access to care. The supplement, with Thomas Rice as guest editor, includes four commentaries on the topic by John Ayanian, Stuart Butler, Karen Davis, and Richard Kronick. The supplement, published by Sage Publications and supported by the Kaiser Commission on Medicaid and the Uninsured (KCMU), features Jack Hadley's exhaustive review of 25 years of research literature. http://www.kff.org/content/2003/4115/

The major findings from the study include:

• The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care (drugs and surgical interventions);
• Having health insurance or access to care would reduce mortality rates for the uninsured by 10-15 percent; and-- "Better" health would improve annual earnings by about 10-30 percent (depending on measures and specific health condition) and would increase educational attainment.

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