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Approximately 45 million Americans, or 15.6 percent of the population, were without health insurance coverage in 2003. The number of uninsured rose 1.4 million between 2002 and 2003.
Nearly 82 million -- about one-third of the population below the age of 65 spent a portion of either 2002 or 2003 without health coverage.
The percentage of people with employment-based health insurance dropped from 70 percent in 1987 to 61 percent in 2004. This is the lowest level of employment-based insurance coverage in more than a decade.
In 2003, 27 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium.
The number of uninsured children in 2003 was 8.4 million - or 11.4 percent of all children.
Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2003 - 30.2 percent of this group did not have health insurance. Based on three year average (2001-2003), people of Hispanic origin were the least likely to have health insurance. An average of 32.8 percent of Hispanics were without health insurance during that time.
Millions of workers don't have the opportunity to get coverage. A third of firms in the U.S. did not offer coverage in 2003. Two-thirds of uninsured workers in 2001 worked for employers who did not offer health benefits.
Nearly two-fifths (38 percent) of all workers are employed in smaller businesses, where less than two-thirds of firms now offer health benefits to their employees.
Rapidly rising health insurance premiums is the main reason cited by all small firms for not offering coverage. Health insurance premiums are rising at extraordinary rates. Over the past five years the average annual increase in inflation has been 2.5 percent while health insurance premiums have escalated an average of 11.4 percent annually.
Even if employees are offered coverage on the job, they can't always afford their portion of the premium. Employee spending for health insurance coverage (employee's share of family coverage and deductibles) has increased 126 percent between 2000 and 2004
Losing a job, or quitting voluntarily, can mean losing affordable coverage - not only for the worker but also for their entire family. Only sevenpercent of the unemployed can afford to pay for COBRA health insurance, the continuation of group coverage offered by their former employees. Premiums for this coverage average almost $700 a month for family coverage and $250 for individual coverage, a very high price given the average $1,100 monthly unemployment check.
Coverage is unstable during life's transitions. A person's link to employer-sponsored coverage can also be cut by a change from full-time to part-time work, or self-employment, retirement or divorce.
About 58 percent of uninsured adults report having changed or lost jobs in 2003. "Job lock" keeps others in positions they might have left if not fear for losing coverage. Job mobility of husbands is 25 percent to 32 percent lower when their wives do not have employment-based health insurance.
Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than the insured.
Regardless of age, race, ethnicity, income or health status, uninsured children were much less likely to have received a well-child checkup within the past year. A recent study shows that nearly 50 percent of uninsured children did not receive a checkup in 2003, almost twice the rate (26 percent) for insured children.
Over one-third of uninsured adults say they did not fill a drug prescription in the 2003 and over a third went without a recommended medical test or treatment due to cost.
The uninsured are increasingly paying "up front" before services will be rendered. When they are unable to pay the full medical bill in cash at the time of service, they can be turned away.
About 20 percent of the uninsured (vs. 3 percent of those with coverage) say their usual source of care is the emergency room.
Studies estimate that the number of excess deaths among uninsured adults age 25-64 is in the range of 18,000 a year. This mortality figure is similar to the 17,500 deaths from diabetes within the same age group.
Over a third of the uninsured had problems paying medical bills in the past year. The unpaid bills were substantial enough that many of the uninsured had been turned over to collection agencies - and nearly a quarter of the uninsured adults said they had changed their way of life significantly to pay medical bills.
Increasingly, the uninsured are more likely to be hospitalized for an "avoidable condition" - problems that could have been prevented had a person received appropriate and timely outpatient care.
A study has found that insured households paid an average of $26,957 in total medical spending after the diagnosis of a serious new health condition; uninsured households paid $42,166.
United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis.
Hospitals provide about $34 billion worth of uncompensated care a year. Over 30 percent of emergency department visits by the uninsured are considered non-urgent.
Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.
The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300.
The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices.
The impacts of uninsurance are clear and severe. There exists a significant sense of vulnerability to the potential loss of health insurance which is shared by tens of millions of other Americans, who have managed to retain coverage in recent years. Every American should have health care coverage, participation should be mandatory, and care should be comprehensive.
