dequate, secure, and accessible health insurance is essential to the future of the United States health care system. Without it, the doors to high-quality medical and preventive care will remain closed to many American families, and catastrophic medical bills will continue to threaten their economic security.
Despite recent efforts to expand health coverage incrementally, the number of uninsured Americans has continued to grow, reaching 43.6 million in 2002, an increase of 2.4 million in a single year. Millions more face erosion in their coverage, higher deductibles, and periods without health insurance.
Comprehensive reform is once again vying for the attention of national and state policymakers. As in the early 1990s, when strategies to achieve comprehensive coverage were last debated, economic forces are chipping away employer-sponsored coverage, squeezing state budgets, and threatening to push even more Americans into the ranks of the uninsured and the under-insured. Gateway cities like New York face the additional challenges of meeting the needs of an increasingly diverse population and investing in the health of an immigrant workforce.
Restructuring the nation's health insurance system to meet the needs of the 21st century is central to the mission of The Commonwealth Fund. Three programs focus on improving coverage and access to care:
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