“At present, about 28 million Americans are uninsured. Repeal of the Patient Protection and Affordable Care Act (ACA) would probably increase this number, whereas enactment of proposed single-payer legislation (1) would reduce it. The public spotlight on how policy changes affect the number of uninsured reflects a widespread assumption that insurance improves health.
A landmark 2002 Institute of Medicine (IOM) report on the effects of insurance coverage on the health status of nonelderly adults buttressed this assumption (2). The IOM committee responsible for the report found consistent evidence from 130 (mostly observational) studies that “the uninsured have poorer health and shortened lives” and that gaining coverage would decrease their all-cause mortality (2).
The IOM committee also reviewed evidence on the effects of health insurance in specific circumstances and medical conditions. It concluded that uninsured patients, even when acutely ill or seriously injured, cannot always obtain needed care and that coverage improves the uptake of essential preventive services and chronic disease management. The report found that uninsured patients with cancer presented with more advanced disease and experienced worse outcomes, including mortality; that uninsured patients with diabetes, cardiovascular disease, end-stage renal disease, HIV infection, and mental illness (the 5 other conditions reviewed in depth) had worse outcomes than did insured patients; and that uninsured inpatients received less and worse-quality care and had higher mortality both during their hospital stays and after discharge.
Woolhandler S, Himmelstein DU. The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?. Ann Intern Med. 2017;167:424–431. [Epub ahead of print 27 June 2017].