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Preface
This is the first report in a series of six that the Institute of Medicine (IOM) Committee on the Consequences of Uninsurance will issue over the next two years to evaluate and consolidate our knowledge of the causes and consequences of lacking health insurance. The Committee was established just one year ago with the charge of reviewing and assessing evidence across a spectrum of disciplines to expand our understanding of the problem of uninsurance. The Committee agreed to undertake this formidable task in order to delineate more clearly the personal, family, community, and economic consequences of the existing public and private health insurance mechanisms--a system that leaves almost one out of six Americans without coverage. This initial report of the Committee establishes both a conceptual framework and baseline data about the magnitude and extent of the problem nationwide. It seeks to answer the basic questions of who, when, where, and why so many Americans lack health insurance. The report provides an overview of health insurance in America, describes the dynamic and often unstable nature of insurance coverage, profiles populations that frequently lack coverage, and identifies factors that make it more or less likely that a person will be uninsured at some point in life. Finally, the report outlines the research agenda that the Committee will pursue in this series of six reports. Many people have made substantial contributions to this report. The Subcommittee on the Status of the Uninsured, chaired by Willard Manning, produced a draft for the full Committee's consideration within an extraordinarily short time and continued to work with the full Committee in revising the initial draft. Committee members John Ayanian, Sheila Davis, Willard Manning, and Larry Wallack were joined on the subcommittee by Peter Cunningham, Paul Fronstin, and Catherine Hoffman, who generously contributed their expertise to the report throughout its conceptualization and drafting. Committee member Ron Andersen advised the subcommittee from the start as it devised the conceptual framework that will be employed throughout the series of studies. IOM staff under Study Co-directors Dianne Wolman and Wilhelmine Miller provided excellent research and writing support to the subcommittee and Committee throughout their deliberations. Program Officer Lynne Snyder served as lead staff analyst on this report. We hope that this report will stimulate public dialogue and a reexamination of long-standing issues of health care financing and continuity of coverage. The Committee's future reports on health outcomes for the uninsured, family impacts of lacking health insurance, implications for communities, the economic costs to society as a whole, and models of reform will provide in-depth and closely considered information that should sustain and hopefully advance policy debates about health care coverage. We are grateful to The Robert Wood Johnson Foundation for its support of the Committee's work.
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