Effects of Insurance Coverage on Use of Care and Health Outcomes for Nonpoor Young Women

摘要

Few health policy issues have been both subjects of more consensus and yet more debate than that of expanding insurance coverage of the uninsured. On the one hand, surveys show that a majority of the public identifies the absence of insurance coverage for 15 percent of the U.S. population as a serious social problem that the government should address. On the other hand, beyond some modest extensions of coverage for lower-income children, there has been little policy action. One commonly hypothesized reason for inaction is the heterogeneity of the uninsured population. If that population were predominantly poor, sick, and unemployed, the need for coverage would be clear, and the target of a subsidy program would be obvious. But most uninsured, while low-income, are not poor, sick, or in families with no employed person. To make a stronger case for coverage of this population, a central rationale for public efforts to expand insurance (i.e., that it improves health outcomes by increasing use of effective medical care) needs to be strengthened. This viewpoint was very strongly taken in a series of recent Institute of Medicine (IOM) reports which argued that "insurance coverage remains one of the most important ways to obtain access to health services" (IOM, 2001 p. 5) and that "[Research studies show that working-age Americans who do not have health insurance have poorer health and die prematurely" (IOM, 2004 p. 44).