National Health Policy Conference AcademyHealth & Health Affairs Panel on Consequences of Uninsurance January 28, 2004

IOM Committee on the Consequences of Uninsurance Task Assess / consolidate evidence about the health, economic and social consequences of uninsurance. Raise awareness and improve understanding by both the general public and policy makers. 6 reports between Fall 2001 and Jan. 2004

Series: Insuring Health 1.Coverage Matters (Oct 2001) presented an overview of insurance and health care. 2.Care Without Coverage (May 2002) documented the health impacts for adults of lacking coverage. 3.Health Insurance Is a Family Matter (September 2002) identified health and financial consequences of the lack of coverage for families.

Series: Insuring Health (cont.) 4. A Shared Destiny (March 2003) traced the effects of uninsured populations on communities’ health services and economic and social vitality. 5.Hidden Costs, Value Lost (June 2003) explores the economic and social effects of uninsurance at the national level. 6.Insuring America’s Health (January 2004) calls for action and sets principles to guide and inform the development of policy solutions.

1. Coverage Matters 80 % of uninsured live in working families Two-thirds live in families earning less than 200 % of FPL Most often not a choice; health insurance is unaffordable for most of uninsured More than 70 million lack coverage at some point over 3 year period

2.Care Without Coverage: Too Little, Too Late Uninsured adults Receive fewer, less timely preventive services Less likely to receive appropriate care for chronic illness, and have worse outcomes Receive poorer hospital-based care Cancer patients in poorer health, more likely to die prematurely

2.Care Without Coverage: Too Little, Too Late (cont.) Continuity of coverage matters Overall, uninsured have a higher risk of dying About 18,000 excess deaths in 2000 among uninsured age 25-64

3. Health Insurance is a Family Matter One uninsured member impacts entire family About 60 million in families with at least one member uninsured Children in uninsured families receive fewer services Children in families with an uninsured parent less likely to receive appropriate care whether or not the child is uninsured.

4. A Shared Destiny: Community Effects of Uninsurance A community’s high uninsured rate can adversely affect its health care institutions and providers, reducing access to services The capacity of clinics and community health centers to serve their clientele, including those with coverage, is strained by large numbers of uninsured patients.

4. A Shared Destiny: Community Effects of Uninsurance (cont.) EMS, trauma care, specialty referrals, services for vulnerable populations are less available Rural hospitals have lower financial margins, fewer ICU beds, less likely to offer high-tech services The financial instability of health care institutions and providers can hurt local economies.

5. Hidden Costs, Value Lost Most of costs of uninsurance are not health care costs Greatest economic losses come from worse health, shorter lives Estimated annual economic value of foregone health for 40 million uninsured is between $65 billion and $130 billion.

5. Hidden Costs, Value Lost (cont.) Cost of health services for those uninsured for any part of a year is about $99 billion (2001) Incremental cost of additional services is $34-$69 billion (2001) About half of annual increment in spending from

18,000 die prematurely. Uninsured children / adults receive fewer and less timely services. 8 million uninsured with chronic illnesses receive fewer services and have increased morbidity and worse outcomes. 41 million uninsured are less likely to receive preventive and screening services. 60 million uninsured individuals and their family members have less financial security and increased life stress due to lack of insurance. People in communities with a higher uninsured rate are at risk for reduced availability of health care services and overtaxed public health resources. All Americans The value of health capital forgone each year due to uninsurance is estimated between $65 and $130 billion