IOM and Kaiser Foundation Release Reports on the Uninsured, IOM Calls for Universal Coverage by 2010

Two new reports—one from the Institute of Medicine (IOM) and the other from the Kaiser Family Foundation—take a close look at the consequences of inadequate health insurance for individuals, their families, communities, and society. Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States, according to the IOM report, Insuring America's Health: Principles and Recommendations. More than 43 million Americans, or 17.2 percent of the population, are uninsured. Although the United States leads the world in spending on health care, it is the only wealthy industrialized nation that does not ensure that all citizens have coverage.

The report, the sixth and last in a series supported by the Robert Wood Johnson Foundation and produced by the IOM's committee on the consequences of "uninsurance," presents evidence to support the committee's prediction that the situation will continue to worsen for the foreseeable future because of federal and state budgetary constraints. The report points out that incremental reforms of public insurance programs over the past 20 years have failed to reduce the national rate of uninsurance, in large part because of poor outreach to and enrollment of eligible persons by state agencies and because of large variations in Medicaid coverage across the states. In addition, federal reforms addressing employment-based insurance have had limited effect because they have not included provisions for ensuring affordability.

The second report, from the Kaiser Family Foundation, summarizes the results of a survey that focused on the effects of inadequate insurance on people with disabilities. Although nearly all adults with disabilities have some form of health insurance, those who lack insurance face the greatest challenges, according to the survey's findings. The report cites research indicating that of the 15.5 million nonelderly adults with serious disabilities, 2.3 million are uninsured. More than two-thirds of the survey respondents without health insurance reported having no regular doctor and postponing care because of cost. A similar proportion reported skipping medication doses, splitting pills, or failing to fill prescriptions and spending less on basics such as food, heat, and other services in order to pay for health care.

The Kaiser findings are based on telephone interviews conducted early last year with a nationally representative sample of more than 1,500 nonelderly adults with physical disabilities (61 percent of the sample), mental disabilities (15 percent), and a combination of physical and mental disabilities (24 percent). In releasing the findings, Drew Altman, Ph.D., president and chief executive officer of the Kaiser Foundation, stated, "Nowhere is the case for providing adequate insurance for people who need it more compelling than when it comes to people with disabilities. This study shows that when the disabled fall through the health insurance cracks, they fall hard."

The IOM report presents a set of guiding principles and a checklist to help policy makers, elected officials, and others compare proposals to extend coverage to the nation's 43 million uninsured. The report does not recommend a specific coverage strategy. Rather, it shows how various approaches could achieve principles articulated by the IOM committee as it brings to a close the most comprehensive investigation to date of the consequences of inadequate insurance.

The committee's overall recommendation is that by 2010 everyone in the United States should have health insurance. The report urges the president and Congress to act immediately by establishing an explicit plan to reach that goal. The committee offers a set of five principles for guiding the debate and assessing policy options:

• Health care coverage should be universal

• Health care coverage should be continuous

• Health care coverage should be affordable to individuals and families

• The health insurance strategy should be affordable and sustainable for society

• Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

Insuring America's Health: Principles and Recommendations can be found on the IOM Web site at www.iom.edu, and Understanding the Health-Care-Needs and Experiences of People With Disabilities: Findings From a 2003 Survey is available on the Kaiser Family Foundation site at www.kff.org.

News Briefs

SAMHSA technical assistance center for treatment of co-occurring disorders: The Substance Abuse and Mental Health Services Administration (SAMHSA) has created a technical assistance center to support state efforts to provide treatment services to persons with co-occurring substance use and mental disorders. The Co-Occurring Center for Excellence (COCE) will identify best practices by using criteria from SAMHSA's National Registry of Effective Programs (http://modelprograms.samhsa.gov). The center will support application of these practices through technical assistance and cross-training, educational materials, and a Web site. The CDM Group, Inc., of Chevy Chase, Maryland, working with the National Development and Research Institutes, Inc., in New York City, the Center for Behavioral Health, Justice & Public Policy at the University of Maryland, and the National Opinion Research Center at the University of Chicago, will operate COCE under a $2.6 million one-year contract renewable for five years. Assistance will be available to all states and to substance abuse, mental health, criminal justice, education, and other social and public health systems. About four million Americans have co-occurring serious mental illness and substance use problems, according to SAMHSA's latest household survey. All requests for technical assistance must be made in writing and sent to Jill Hensley, Project Director, COCE, 5530 Wisconsin Avenue, Suite 1600, Chevy Chase, Maryland 20815 or by e-mail to [email protected]. For questions about specific services, contact the COCE team at 301-951-3369.

NMHA survey on depression among working women: A survey released by the National Mental Health Association (NMHA) and the American Medical Women's Association found that 83 percent of working women with depression cited the disorder as the greatest barrier to success in the workplace. The women found depression to be a greater obstacle to success than other barriers, such as child- and elder-care responsibilities, pregnancy, and sexual harassment. Depression affects about five million employed American women each year, according to the survey report. Respondents identified common problematic behaviors associated with their illness, such as leaving work early or not returning from lunch, avoiding contact with coworkers, and being unable to face work. Ninety-four percent of respondents who sought treatment noticed improvements at work. However, fewer than half of those who received treatment sought it immediately. These women stated that they did not know where to go for help, felt pressure from work-related time constraints, feared that their health insurance would not cover the costs, and worried that they could lose their jobs. Survey interviews were conducted with 751 employed women in April and May 2003. Among the women surveyed, 250 had significant symptoms of depression but had not received a diagnosis at the time of the survey, and the remaining 501 reported a previous diagnosis of depression. Key findings of the survey, Depression Among Women in the Workplace, are available on the NMHA Web site at www.nmha.org.

Resources for information on new Medicare legislation: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 mandates the largest expansion of the Medicare program since 1965. In the wake of the act's passage in December, many providers and consumers have voiced questions and concerns about its complex and varied provisions. The Kaiser Family Foundation has compiled a list of nearly 20 downloadable reports, charts, Webcasts, video presentations, fact sheets, frequently asked questions, and surveys from an array of sources that present current analyses of the legislation as well as background information. These resources are available on the Kaiser Foundation's Web site at www.kff.org. In addition, the Centers for Medicare and Medicaid Services (CMS) has created a new online series—Medicare Issue of the Day—to introduce and explain the new provisions. Among recent fact sheets are "Health Savings Accounts for All," "Payment Reforms for Hospital Outpatient Services," and "Medicare Endorsed Prescription Drug Discount Card." The fact sheets are available on the CMS Web site at http://cms.hhs.gov.

Americans' understanding of the psychological nature of terrorism: A new survey has found that most Americans understand the effects of terrorism on mental health and believe that elected officials and health networks have not done enough to address mental health needs related to terrorist threats. The survey report, Public Perspectives on the Mental Health Effects of Terrorism, summarizes findings from a nationally representative telephone survey conducted in December 2003 among 750 American adults for the National Association of State Mental Health Program Directors (NASMHPD) and the National Mental Health Association (NMHA). Nearly all respondents (93 percent) agreed that the primary goal of a terrorist attack is to generate fear and distress. More than 80 percent said that they expected another terrorist attack in the near future. Only a quarter believed that the nation's public health system is meeting terrorism-related mental health needs. "This survey demonstrates that waging the war on terror is about more than airport checkpoints and duct tape," said Robert Glover, Ph.D., executive director of NASMHPD. "Most Americans are resigned to the belief that we will suffer another attack and think it is just as important for the government to develop programs that deal with fear and distress as it is to take security precautions at physical installations such as airports." The report is available on the NMHA Web site at www.nhma.org.

SAMHSA call for grant reviewers: The three centers of the Substance Abuse and Mental Health Services Administration (SAMHSA) are seeking professionals to evaluate applications for federal grants. Reviewers are chosen for particular grant programs, on the basis of their knowledge, education, and experience. Minimum requirements for reviewers, descriptions of areas of expertise of interest to the agency, a list of some of the benefits of serving as a reviewer, and application materials can be found on SAMHSA's Web site at www.samhsa.gov. Reviewers selected will receive taxable compensation for their services. Applications will be accepted at any time. However, reviewers who wish to be considered for the fiscal year 2004 grant cycle must submit applications by June 30, 2004.