Contents

Title Page and Notice		i
National Academies Statement		iv
Committee		v
Reviewers		vii
Preface		ix
Foreword		xi
Acknowledgments		xiii
EXECUTIVE SUMMARY		1
	Myths and Realities	2
	Relating Health Insurance to Access to Health Services	5
	How Coverage Is Gained and Lost	6
	A Portrait of the Uninsured	11
	Analytic Plan for the Committee	14
	Summary	15
1	WHY HEALTH INSURANCE MATTERS	19
	Objectives of Health Insurance Coverage	20
	Myths and Realities About Health Insurance	21
	The Committee's Analytic Strategy	26
	Insurance and Access to Health Care	28
	What Follows	32
2	THE DYNAMICS OF HEALTH INSURANCE COVERAGE	35
	No Guarantee of Coverage	35
	Opportunities for Obtaining Coverage	37
	How People Gain and Lose Coverage	46
	Constrained Coverage Options	49
	Insurance Trends	53
	Summary	56
3	WHO GOES WITHOUT HEALTH INSURANCE? WHO IS MOST LIKELY TO BE UNINSURED?	59
	How Social and Economic Factors Affect Coverage	60
	How Coverage Varies Over a Person's Life	70
	Other Demographic Disparities in Coverage	80
	How Geographic Differences Affect Coverage	90
	What Influences an Uninsured Rate the Most?	96
	Summary	98
4	ANALYTIC PLAN	101
	Future Committee Reports	101
APPENDIXES
A	A Conceptual Framework for Evaluating the Consequences of Uninsurance: A Cascade of Effects	109
B	Measuring Insurance Coverage and Insurance Rates	113
C	Data Tables	119
D	Multivariate Analysis	135
E	Glossary	143
F	Biographical Sketches	149
REFERENCES		157