Previous IOM Findings on the Consequences of Uninsurance, 2004

The clinical literature overwhelmingly shows that uninsured people, children as well as adults, suffer worse health and die sooner than those with insurance. Families with even one member who is uninsured lose peace of mind and can become burdened with enormous medical bills. Uninsurance at the community level is associated with financial instability for health care providers and institutions, reduced hospital services and capacity, and significant cuts in public health programs, which may diminish access to certain types of care for all residents, even those who have coverage. The economic vitality of the nation is limited by productivity lost as a result of the poorer health and premature death or disability of uninsured workers.

of crisis. There is no evidence to suggest that the trends driving loss of insurance coverage will reverse without concerted action.

With a new administration and a new Congress in 2009, many citizens, policy makers, and opinion leaders anticipate renewed energy and interest in finding a way to reverse declines in health insurance coverage and, ultimately, to expand coverage to all in the United States. It is in this context that the Robert Wood Johnson Foundation asked the IOM to conduct the present study. In response to the Foundation’s request, the IOM appointed the Committee on Health Insurance Status and Its Consequences in April 2008.

The committee’s charge was to review and evaluate the research evidence on the health and other consequences of uninsurance that has emerged since the IOM’s earlier series of reports that might help inform the health care reform efforts in 2009 (Box S-2). Whereas the previous IOM studies on uninsurance were broad and comprehensive in scope, the present study focuses more narrowly on the following critical 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?


In executing its charge, the committee has studied the research literature since 2002 and applied rigorous scientific criteria to set the record straight on the issue of health insurance coverage. The committee reports findings in three key areas: (1) trends in health insurance coverage and forces driving

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