When policy makers and researchers consider potential solutions to the crisis of uninsurance in the United States, the question of whether health insurance matters to health is often an issue. This question is far more than an academic concern. It is crucial that U.S. health care policy be informed with current and valid evidence on the consequences of uninsurance for health care and health outcomes, especially for the 45.7 million individuals without health insurance.

From 2001 to 2004, the Institute of Medicine (IOM) issued six reports, which concluded that being uninsured was hazardous to people's health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all.

The goal of this book is to inform the health reform policy debate--in 2009--with an up-to-date assessment of the research evidence. This report addresses three key questions:

1. What are the dynamics driving downward trends in health insurance coverage?
2. Is being uninsured harmful to the health of children and adults?
3. Are insured people affected by high rates of uninsurance in their communities?

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON HEALTH INSURANCE STATUS AND ITS CONSEQUENCES
• Reviewers
• Foreword
• Preface
• Acknowledgments
• Summary
• 1. Introduction
  • OBJECTIVE OF THE STUDY
  • WHAT IS THE PURPOSE OF HEALTH INSURANCE?
  • PREVIOUS IOM REPORTS ON UNINSURANCE
  • SCOPE AND METHODS OF THE STUDY
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Caught in a Downward Spiral
  • SNAPSHOT OF TRENDS IN HEALTH INSURANCE COVERAGE
  • THE FORCES BEHIND THE DOWNWARD SPIRAL IN HEALTH INSURANCE COVERAGE
  • LIMITATIONS OF THE NONGROUP HEALTH INSURANCE MARKET
  • ECONOMIC PRESSURES THREATENING PUBLIC COVERAGE EXPANSIONS
  • CONCLUSION
  • REFERENCES
• 3. Coverage Matters
  • CONCEPTUAL FRAMEWORK
  • METHOD OF THE REVIEW
  • FINDINGS
  • CONCLUSION
  • REFERENCES
• 4. Communities at Risk
  • CONTEXT FOR ASSESSING COMMUNITY-LEVEL CONSEQUENCES OF UNINSURANCE
  • HOW THE INSURED POPULATION IN A COMMUNITY MAY BE AFFECTED BY HIGH RATES OF UNINSURANCE
  • VULNERABILITIES IN LOCAL HEALTH CARE DELIVERY
  • CONCLUSION
  • REFERENCES
• 5. Summary of Findings and Recommendation
  • COMMITTEE’S RESOLUTION AND RECOMMENDATION
  • SUMMARY OF FINDINGS
  • CONCLUSION
  • REFERENCE
• Appendix A Executive Summary of the 2004 IOM Report Insuring America’s Health: Principles and Recommendations
• Appendix B Statistics on the Nonelderly U.S. Population Without Health Insurance, 2007
• Appendix C State Regulations Promoting Access to Individual Health Insurance Policies, 2007
• Appendix D Recent Studies of the Impacts of Health Insurance for Children: Summary Tables
• Appendix E Recent Studies of the Impacts of Health Insurance for Adults: Summary Table
• Appendix F Committee Biographies

This study was supported by Contract No. 63982 between the National Academy of Sciences and the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2009. America’s Uninsured Crisis: Consequences for Health and Health Care. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.