More U.S. Residents Will Lose Health Coverage as Economy Weakens, Health Insurance Becomes More Costly, Fewer Employers Offer Coverage, IOM Says

More U.S. residents will lose their health insurance as the economy weakens, health care costs increase and fewer companies offer coverage to employees, according to a report released on Tuesday by the Institute of Medicine, Reuters reports (Dunham, Reuters, 2/24). For the report, sponsored by the Robert Wood Johnson Foundation, the IOM Health Research Committee provided an updated assessment of research evidence based on a six-part series that the agency published between 2000 and 2004 on the effects of a lack of health insurance on children, adults, families and communities (Skotzko, CQ HealthBeat, 2/24).

According to the report, many companies have begun to replace full-time positions with part-time, contract and temporary positions that do not include health insurance. The report also found that increased health insurance premiums have prompted more employees not to participate in plans offered by companies; the average annual employee premium contribution for family coverage increased from $1,543 to $3,354 between 1999 and 2008, according to the report.

The economic recession and increasing health care costs also might make recent expansions of state health insurance programs, such as Medicaid and CHIP, unsustainable, the report found. In addition, the report found that safety-net services, such as charity and emergency care provided by hospitals, will not meet the needs of the increased number of residents who lose health insurance (Reuters, 2/24).

The report also found that residents who have health insurance but live in geographic areas with high rates of uninsurance are more likely to experience problems with specialty care and health care delivery, such as limited inpatient bed capacity and untimely trauma and outpatient emergency care. In addition, residents of such areas who have health insurance also are less likely to report satisfaction with the health care that they receive, according to the report (CQ HealthBeat, 2/24).

Recommendations
The report recommends that President Obama and Congress enact legislation to expand health insurance to all residents. The report states, "There is never a perfect opportunity for reform. This is the time to act" (Graham, "Triage," Chicago Tribune, 2/24). The report adds, "The lack of health insurance coverage for tens of millions of Americans cannot be ignored and should not be a chronic underpinning of American health care -- it is in fact treatable and indeed preventable" (Reuters, 2/24).

Comments
IOM President Harvey Fineberg said, "If you lack insurance, you suffer the consequences, and your family suffers the consequences and your community suffers the consequences" (CQ HealthBeat, 2/24). Committee Chair Lawrence Levin, a health care consultant, said, "The evidence clearly shows that lack of health insurance is hazardous to one's health, and the situation is getting worse because of the erosion of employment-based health coverage due to the current economic crisis" (Reuters, 2/24).

House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) said that the report "makes clear that health reform is as much about protecting the health of people who have coverage today as it is about covering the millions of Americans who are uninsured." He added, "Until we have a health system that covers everyone, we will exacerbate disparities in access to medical treatment around our country. We need to reform our health system for the health of us all."

Families USA Deputy Executive Director Kathleen Stoll said, "The big takeaway is that we all have a stake, whether we have insurance or not" (CQ HealthBeat, 2/24).

A brief on the report is available online.