old and for the year 2001). The West South Central, Pacific, and Mountain regions, with uninsured rates of 24.3 percent, 19.7 percent, and 18.6 percent, respectively, have uninsured rates well above the national average (16.5 percent). The states with the highest number of uninsured persons tend to be those with the largest populations, including California (6.7 million uninsured), Texas (4.9 million), New York (2.9 million), and Florida (2.8 million). Uninsured rates show less of a direct relationship with population size; the border state of New Mexico, for example, is home to just 1 percent of the uninsured population nationally (an estimated 400,000 uninsured persons) but has one of the highest uninsured rates (23.9 percent) of all the states. Reflecting the predominantly urban location of the U.S. population, 82 percent of uninsured persons live in urban areas. However, urban and rural (non-urban) residents are about equally likely to be uninsured (rates of 16.5 percent and 16.8 percent, respectively). See Tables C.1, C.2, and C.3 for more information about the regional distribution of the uninsured population.

Coverage Matters: Insurance and Health Care, the Committee’s first report, shows that uninsured persons in the United States are predominantly workers or members of families in which someone had paid employment. It finds that many Americans lacked coverage because their employers did not offer it and workers were unable to afford policies without an employer contribution. Coverage Matters also identifies the unstable nature of health insurance coverage for Americans younger than 65—those with coverage today could lose it tomorrow for any number of reasons. However, at age 65, virtually everyone becomes permanently entitled to Medicare coverage.

The second report, Care Without Coverage: Too Little, Too Late, compares health outcomes for insured and uninsured adults, concluding that the lack of health insurance results in consistently worse health outcomes, including premature death, for adults. These poor outcomes result from deficits in access, use, and quality of health care across the spectrum of preventive, acute, and chronic care services.

Health Insurance Is a Family Matter, the Committee’s third report, breaks new ground in examining the effects of a lack of coverage by anyone in a family on the family as a whole and the implications for children’s health when they or their parents do not have coverage. The Committee concludes in its third report that the health, emotional well-being, and financial stability of families are at risk when even one member is uninsured. Thus, at a time when an estimated 38 million Americans lacked coverage (2000), another 20 million insured family members shared the financial risk and threats to peace of mind and even to their own health.

The lack of health insurance coverage within a population is frequently understood as a problem only for those who are immediately affected, namely, those without coverage and their families. A Shared Destiny explores whether and how many of us can be affected by the stark differences in financial access and resources available to those who have and those who don’t have health insurance. Our health care institutions and the vitality of our neighborhoods, cities, towns,

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