A Family Matter

When a member of a family is sick, the whole family can be affected. This report examines whether having an uninsured member of the family might affect the entire family, also. More than 38 million Americans are uninsured.1 In addition to the personal consequences for those people without coverage, another nearly 20 million immediate family members who are insured may also be affected by the lack of coverage of others in the family.2,3 This report will assess the literature on the physical and psychological health consequences as well as financial effects on the entire family unit of having one or more members uninsured.

This report of the Institute of Medicine (IOM) Committee on the Consequences of Uninsurance provides new analyses of the effects of not having health insurance within families (see Box 1.2). The Committee builds on the first report, Coverage Matters, which examines the dynamic, fragmented structure of health insurance in the United States, the causes of uninsurance, and which individuals


The Committee’s earlier reports refer to roughly 40 million uninsured individuals, based on the 1999 and 2000 Current Population Surveys (CPS). The 2001 CPS was available for this report and shows a dip to 38.7 million uninsured persons (Mills, 2001).


Analyses in this report are based on tabulations of the March 2001 Current Population Survey (CPS) public use file designed to aggregate data by family units conducted by Matthew Broaddus, Center on Budget and Policy Priorities.


The CPS estimates those who have been uninsured for the complete year. It has been criticized for probably over-estimating that number and underestimating the number covered by Medicaid. For example, in 1996 the CPS estimate of the number of nonelderly uninsured persons was 41 million and Medical Expenditure Panel Survey estimated 32 million for that year (Lewis et al., 1998; Fronstin, 2000). For a discussion of the main national surveys including insurance status see Coverage Matters, Appendix B.

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