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Executive Summary
Pages 1-17

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From page 1...
... This report and the five reports that will follow endeavor to present a wideangle view of health insurance and examine the consequences of being without insurance, not only for persons who are uninsured and their families, but also for the communities in which they live and for society. Health insurance is one of the best-known and most common means used to obtain access to health care.
From page 2...
... Reality: The number of uninsured people is greater than the combined populations of Texas, Florida, and Connecticut. During 1999, the Census Bureau estimated that approximately 42 million people in the United States lacked health insurance coverage (Mills, 2000~.
From page 3...
... , conducted annually by the Census Bureau, is the most widely cited source of estimates of the number of uninsured persons and is used throughout this report as the primary data source. The CPS is particularly useful because it produces yearly estimates in a timely fashion, reporting the previous year's insurance coverage rates each September, and because information about insurance coverage has been gathered since the mid-1970s, allowing for analysis of coverage trends over time (Figure ES.1~.
From page 4...
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From page 5...
... RELATING HEALTH INSURANCE TO ACCESS TO HEALTH SERVICES Health insurance serves multiple constituencies and distinct purposes. For individuals and families, insurance coverage is one means to promote health and access to care and to protect against exceptional health care costs.
From page 6...
... Uninsured adults are less likely to receive health services, even for certain serious conditions. One nationally representative survey that took into account age, sex, income, and health status found that uninsured people were less than half as likely as those with insurance to receive needed care, as judged by physicians, for a serious medical condition (Baker et al., 2000~.
From page 7...
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From page 8...
... . O ~ 1 0 Come people report multiple sources of coverage, so employment-based, individual, and public insurance coverage rates total more than the 82 percent of the u.s.
From page 10...
... Yet even short periods without insurance carry with them the financial risk of extraordinarily high health expenses. Limited Coverage Options Insurance industry underwriting practices, the costs of health services, and the patchwork of public policies regarding insurance coverage all contribute to the economic pressures on employers, insurers, and government programs offering health insurance.
From page 11...
... Coverage Trends over Time Since the mid-1970s, growth in the cost of health insurance has outpaced the rise in real income, creating a gap in purchasing ability that has added roughly one million persons to the ranks of the uninsured each year. These cost increases result in part from advances in medical and pharmaceutical technology, an aging population, and reduced consumer sensitivity to prices through expanded insurance coverage (Healer et al., 2001~.
From page 12...
... Differences among the states with respect to population characteristics, industrial economic base, eligibility for public insurance, and relative purchasing power of family income shape the geographic disparities in insurance coverage rates (Figure ES.4) (Marsteller et al., 1998; Brown et al., 2000b; Cunningham and Ginsburg, 2001~.
From page 13...
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From page 14...
... The conceptual framework developed in this report will guide the analyses in each of the subsequent reports, which will include examinations of health outcomes, financial impacts, and changes in the quality of life that result from the lack of health insurance. Report 2: Health Consequences for Individuals We know that insurance coverage facilitates access to health services, but what effects does the lack of health insurance have on health?
From page 15...
... The most apparent deficits in care experienced by those without insurance are for chronic conditions and in preventive and screening services (HaLner-Eaton, 1993; Ayanian et al., 2000; Baker et al., 2000; Schoen and DesRoches, 2000~. Far too often, key aspects of quality health care, regular care and communication with a provider to prevent and manage chronic health conditions (Institute of Medicine, 2001)
From page 16...
... Current public policies and insurance practices will sustain a large uninsured population under a range of projected scenarios for the national economy (Custer and Ketsche, 2000a; Fronstin, 2001~. The decline in the number of uninsured people between 1997 and 1999 is not expected to continue if the economy remains slow and health care costs and insurance premiums continue to rise rapidly.


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