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Date: Jan. 14, 2004
Contacts: Christine Stencel, Media Relations Officer
Chris Dobbins, Media Relations Assistant
202-334-2138; e-mail <>


IOM Report Calls for Universal Health Coverage by 2010;
Offers Principles to Judge, Compare Proposed Solutions

WASHINGTON -- Given the growing stress being placed on the nation's health care system, the exacerbated health problems, and the substantial societal costs that result from more than 43 million Americans lacking health insurance, the president and Congress should strive to achieve universal health coverage in the United States by 2010, says a new report from the Institute of Medicine of the National Academies. The committee that wrote the report offered five guiding principles by which all proposals for extending coverage should be judged.

"Lack of health insurance in the United States is a critical problem that can and should be eliminated," said committee co-chair Mary Sue Coleman, president, University of Michigan, Ann Arbor. "Achieving universal coverage will require federal leadership and support, regardless of which strategy is adopted to achieve this goal."

Presenting a specific strategy or blueprint for achieving universal coverage was not within the purview of the committee, which was charged with assessing and consolidating the evidence about the nation's current approach to health insurance. "Our purpose was to help policy-makers determine the best path to universal coverage by offering a set of principles by which the merits and limitations of proposed strategies can be assessed and compared," Coleman explained. "There are many thoughtful plans for extending health insurance already on the table. We leave the debate about the specifics and exact design of the necessary health insurance reforms to elected officials, policy-makers, and the public."

The principles are based on the evidence and conclusions reached in the committee's five previous reports, which documented the consequences of lack of health insurance. Among the findings, these reports noted that:

¨ Uninsured Americans get about half the medical care of those with health insurance. As a result, they tend to be sicker and to die sooner.
¨ About 18,000 unnecessary deaths occur each year because of lack of health insurance.
¨ Only half of uninsured children visited a physician during 2001, compared with three-quarters of insured children. Lack of regular care can result in more expensive care for preventable or treatable conditions, and disruptions in learning and development.
¨ When even one family member is uninsured, the entire family is at risk for the financial consequences of a catastrophic illness or injury.
¨ Tax dollars paid for an estimated 85 percent of the roughly $35 billion in unreimbursed medical care for the uninsured in 2001.
¨ The burden of uncompensated care has been a factor in the closure of some hospitals and the unavailability of services in others. Disruptions in service can affect all who are served by a facility, even those who have health insurance.
¨ The United States loses the equivalent of $65 billion to $130 billion annually as a result of the poor health and early deaths of uninsured adults.

"In light of the adverse consequences that uninsurance has for individuals, families, communities, and society as a whole, it should be painfully clear that our nation can no longer afford to ignore this problem," said committee co-chair Arthur Kellermann, professor and chair of emergency medicine at Emory University School of Medicine, Atlanta. "We must find a way to cover the uninsured."

The committee's five guiding principles to judge proposed solutions are:

1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable to society.
5. Health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

The first principle -- that coverage be universal -- is the most basic and important. "Any proposal that leaves a significant number of Americans without coverage will allow the consequences we enumerated in our previous reports to continue," Kellermann said.

To demonstrate how the principles would facilitate decision-making, the committee used them to assess four generic solutions to covering the uninsured. These prototypes include aspects of the broad range of proposals currently under debate, such as expansions of current public insurance programs, mandates on employers to provide coverage or individuals to purchase it, tax credits to subsidize premium costs, and a single-payer approach. However, none of the examples precisely reflects the proposal of any specific individual or group.

The committee's assessments reveal that each generic solution has strengths and weaknesses, suggesting that not only could individual strategies be improved with further refinements, but also that the best approach might wed the stronger elements of different proposals. However, any of these prototypes does a better job of meeting the five principles than the status quo, the report says.

The escalating costs of the current situation call for prompt action, the report says. The committee set the target date of 2010 for achieving universal coverage to allow for the development, adoption, and implementation of a comprehensive coverage strategy. This date also is consistent with the federal government's own Healthy People 2010 initiative to increase Americans' life spans and quality of life and to eliminate disparities in health among different groups. The first objective of the initiative's "Access to Health Care" goal is to increase coverage to 100 percent by 2010.

The committee recognized the current economic pressures on all levels of government and acknowledged that any plan to expand coverage likely will require additional public funding. Because the additional necessary funds depend on many variables, such as the particular benefit packages, the committee was unable to specify how much any of the prototype plans might cost. However, proposals that reduce the amount of time and resources needed to administer coverage could result in substantial cost savings, which could be used to offset the funding increases. Furthermore, the country will reap significant economic benefits from the improved health and enhanced life expectancy that will result from covering the uninsured.

This is the final report in a six-part series sponsored by the Robert Wood Johnson Foundation. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.

Copies of Insuring America's Health: Principles and Recommendations are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at The cost of the report is $27.00 (prepaid) plus shipping charges of $4.50 for the first copy and $.95 for each additional copy. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

[ This news release and the report are available at ]

Board on Health Care Services

Committee on the Consequences of Uninsurance

Mary Sue Coleman, Ph.D. (co-chair)
University of Michigan
Ann Arbor

Arthur L. Kellermann, M.D., M.P.H. * (co-chair)
Professor and Chairman
Department of Emergency Medicine, and
Director, Center for Injury Control
Rollins School of Public Health
Emory University School of Medicine

Ronald M. Andersen, Ph.D.
Fred W. and Pamela K. Wasserman Professor of Health Services and Chair
Department of Health Services, and
Professor of Sociology
School of Public Health
University of California
Los Angeles

John Z. Ayanian, M.D., M.P.P.
Associate Professor of Medicine and Health Care Policy
Department of Health Care Policy
Harvard Medical School

Robert J. Blendon, M.B.A., Sc.D. *
Professor of Health Policy and Political Analysis
Department of Health Policy and Management
Harvard School of Public Health and John F. Kennedy School of Government

Sheila P. Davis, B.S.N., M.S.N., Ph.D.
Department of Adult Health
School of Nursing
University of Mississippi Medical Center

George C. Eads, Ph.D.
Vice President and Director
Charles River Associates
Washington, D.C.

Sandra R. Hernández, M.D.
Chief Executive Officer
San Francisco Foundation
San Francisco

Willard G. Manning, Ph.D.
Department of Health Studies
Pritzker School of Medicine and
Harris School of Public Policy
University of Chicago

James J. Mongan, M.D.
President and Chief Executive Officer
Partners Healthcare Inc.

Christopher Queram, M.A.
Chief Executive Officer
Employer Health Care Alliance Cooperative
Madison, Wis.

Shoshanna Sofaer, Dr.P.H.
Robert P. Luciano Professor of Health Care Policy
School of Public Affairs
Baruch College
New York City

Stephen J. Trejo, Ph.D.
Associate Professor of Economics
Department of Economics
University of Texas

Reed V. Tuckson, M.D.
Senior Vice President
Consumer Health and Medical Care Advancement
UnitedHealth Group
Minnetonka, Minn.

Edward H. Wagner, M.D., M.P.H., F.A.C.P.
W.A. MacColl Institute for Healthcare Innovation
Center for Health Studies
Group Health Cooperative of Puget Sound

Lawrence Wallack, Dr.P.H.
Professor of Public Health and Director
School of Community Health
College of Urban and Public Affairs
Portland State University
Portland, Ore.


Wilhelmine Miller, M.S., Ph.D.
Study Co-Director

Dianne Miller Wolman, M.G.A.
Study Co-Director

Lynne Page Snyder, Ph.D. M.P.H.
Program Officer

* Served from September 2000 to December 2002