[DanaC]

From a keynote address from the President of the University of Michigan 2003, based on the findings of the Committee on the Consequences of Uninsurance:

Let’s start with the myths:

Myth #1: People without health insurance get the medical care they need.
Reality: Over and over, studies show that those without health insurance are less than half as likely to receive needed medical care.

They are much less likely to have a physician visit within a year, have fewer visits annually, and they are more than three times as likely to lack a regular source of care. They also are less likely to receive preventive services and appropriate routine care for chronic conditions than those with insurance.

Myth #2: The number of Americans without health insurance is not large and has not been growing.
Reality: The Census Bureau estimates 38 million to 42 million people in the United States lacked health insurance coverage in 1999.

That is about 15 percent of the total population of 274 million persons and 17 percent of the population under 65. Unfortunately, this intractable problem has persisted for many years.

Myth #3: Most people without health insurance decline coverage offered in the workplace because they are young and healthy and do not think they need it.
Reality: Young adults are more likely to be uninsured mostly because they are ineligible for workplace coverage. Only 3 million workers between 18 and 44 are uninsured because they decline workplace health insurance. Eleven million workers between 18 and 44 are uninsured because their employer does not offer them coverage.

Myth #4: Most of the uninsured do not work, or they live in families where no one works.
Reality: More than 80 percent of uninsured children and adults under the age of 65 live in working families.

Myth #5: Recent immigrants account for the increase in the number of uninsured persons.
Reality: Immigrants who have come to the United States within four years comprise a relatively small proportion of the general population [SLIDE 14]. Non-citizens represent less than one in five uninsured persons.

Let me summarize for you the principle ways that people living in this country gain or lose insurance coverage:

Employment-based insurance is by far the most common type of coverage available.
Some of us are able to purchase insurance on our own, if we can qualify, but the premiums are very expensive.
Insurance can be acquired through marriage to an insured person.
Or, it is possible to qualify for public insurance, such as Medicaid and Medicare.
But because most insurance is employment-based, families who have enjoyed excellent health insurance coverage for years may suddenly lose this safety net when a working parent changes jobs, is laid off, dies, or divorces.

Money may not buy love, happiness, or good health, but there is a strong correlation between family income and having health insurance. In lower income families, only 59 percent are able to obtain insurance for the whole family.
You are less likely to have insurance for some family members if your family is headed by a single parent, or you recently immigrated to the U.S., or you are a member of a racial or ethnic minority group.

So, who are the uninsured?

As I noted earlier, many of the uninsured are employed.
The uninsured are likely to have at least one wage earner in the family, but to earn less than 200 percent of the federal poverty baseline, and to lack a college education.
They also are likely to be self-employed, employed by a small firm of fewer than 100 workers.
In terms of life stage, the uninsured are most likely to be adults and young adults, unmarried, and members of families that include children.
The probability of being uninsured varies vastly by geographic region. You can see that Michigan ranks among the states with a high level of uninsurance.

In our work, we evaluated the literature about the health consequences of uninsurance, because establishing this link is critical to shaping public policy and gaining support for widespread health care financing.

Let me give you the “punch line” first:

The committee finds a consistent relationship between health insurance coverage and health outcomes for adults.
Coverage is associated with having a regular source of care, which promotes continuity of care. The ultimate result is improved health outcomes.
We concluded that health insurance is associated with better health outcomes for adults and with their receipt of appropriate care across a range of preventive, chronic, and acute care services. Adults without health insurance coverage die sooner and experience greater declines in health over time.
Let me provide a sense of some of the many findings that have led us to this conclusion:

Long-term, well-controlled studies of mortality reveal a higher risk of dying prematurely for those who were uninsured at the beginning of the study than for those who initially had private coverage.
These studies have shown that adults who are initially uninsured have a 25 percent greater risk of dying prematurely than adults with private insurance.
Follow-up studies have shown that black men and white women who were uninsured had a 50 percent greater risk of dying prematurely than their insured counterparts, and uninsured white men had a 20 percent higher risk.
Because of delays in diagnosis, uninsured persons are more likely to die prematurely than persons with insurance. Tragically, uninsured women diagnosed with breast cancer have a 30 percent to 50 percent higher risk of dying than women with private insurance. Uninsured women are more likely to receive a late-stage diagnosis of cervical cancer than are women with any kind of insurance.
Adults with diabetes who are without insurance are less likely to receive recommended services such as foot exams or dilated eye exams.
Among adults with HIV, having health insurance has shown to reduce the risk of dying within a six-month period by over 70 percent. Uninsured adults with HIV infection are less likely to receive highly effective medications that have been shown to improve survival.

http://www.umich.edu/pres/speeches/030519vodi.html