AJPH | Health Insurance and Mortality in US Adults

September 18, 2009

Wilper, Andrew P., Woolhandler, Steffie, Lasser, Karen E., McCormick, Danny, Bor, David H., Himmelstein, David U. Health Insurance and Mortality in US Adults. Am J Public Health December 2009; 99(12). AJPH First Look, published online ahead of print Sep 17, 2009. [Abstract (html)][Full Text (pdf)]

The Institute of Medicine earlier calculated 18, 314 excess deaths among uninsured adults age 25-64 in 2000. Using the same method, this study estimates there were 35,327 excess deaths among uninsured adults 18-64 in 2005. An alternative calculation using the global hazard ratio for uninsured adults rather than age-specific hazard ratios, shows the number of excess deaths may be as high as 44, 789.

Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.

Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death.

Results. Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance.

Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.


Changes in the Content of Developmental Care with Enrollment in Health Insurance | Patricia Barreto and Moira Inkelas: Urban Institute

September 15, 2009

Patricia Barreto and Moira Inkelas. Changes in the Content of Developmental Care with Enrollment in Health Insurance. Washington, DC: Urban Institute, September 15, 2009.

Enrollment in Healthy Kids is associated with some improvement in eliciting parent concerns and providing health education, but participation did not increase information for parents about their concerns or affect the proportion of children for whom parents have some type of concern regarding learning, development or behavior. The lack of improvement in these areas despite enrollment in a medical insurance program likely results from larger systems-level barriers to adequate developmental assessment/monitoring and anticipatory guidance within primary care. Findings suggest these barriers such as time, competing demands, and incentives in primary care are not reduced simply by enrollment in health insurance. More at Urban Institute


Census Bureau | Income, Poverty, and Health Insurance Coverage in the United States: 2008

September 15, 2009

DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008, U.S. Government Printing Office, Washington, DC, 2009. [Full Text (pdf)]

Figures from the March 2009 Current Population Survey show there were 46.3 million uninsured in 2008. According to the CPS, the overall risk of being uninsured rose from 12.9% in 1987 to 15.4% in 2008, with the highest recorded rate (15.8%) occurring in 1998 and 2006.


Treasury Department | The Risk of Losing Health Insurance Over a Decade

September 12, 2009

U.S. Department of Treasury. The Risk of Losing Health Insurance Over a Decade: New Findings from Longitudinal Data. September 12, 2010. [Full Text (pdf)]

Major Findings on Ten-Year Uninsurance Rates for Non-elderly Americans

  • 48 percent are uninsured at some point over a ten-year span
  • 41 percent go without coverage for at least six months over a ten-year span
  • 36 percent go without coverage for at least one year over a ten-year span
  • 32 percent of people who are covered for all 12 months of a given year go without coverage at some point during the following nine years
  • 57 percent of Americans under age 21 are insured at some point over a ten-year span
  • 53 percent of Americans in rural areas go without insurance over a ten-year span
  • 45 percent of Americans with household incomes between $50,000-$100,000 (ten-year average) go without insurance at some point over a ten-year span

CBO | Supplemental Information on Potential Effects of the Affordable Health Choices Act

September 11, 2009

Congressional Budget Office. Supplemental Information on Potential Effects of the Affordable Health Choices Act. Letter to the Honorable Michael B. Enzi. September 10, 2009. [Full Text (pdf)]

This letter addresses:

  • the potential impact of including all Americans under 150% of poverty in Medicaid (would add about $500 billion in spending, but potentially assist about half the uninsured);
  • whether penalty payments by employers that do not offer coverage would be borne by workers in the form of lower wages (they would);
  • whether employees might lose existing coverage (about 6 million would, but this is offset by 7 million others who would gain employer-based coverage);
  • the impact of a public plan on the federal budget (little net effect, but “the federal government would be assuming the financial risk that the premiums charged in any given year might not fully cover all of the public plan’s costs”); and
  • the net impact on health spending (“the bill would probably increase national spending on health care modestly”).

The Obama Plan in 4 Minutes | The White House: YouTube

September 10, 2009

via YouTube – The Obama Plan in 4 Minutes.


In Full: Obama Health Care Address | CBS: YouTube

September 9, 2009

In Full: Obama Health Care Address

via YouTube – In Full: Obama Health Care Address.