An array of Task Force projects documented the negative consequences of being uninsured or inadequately insured. A study⁽³⁰⁾ by Michael Gusmano, of the International Longevity Center-USA, and Gerry Fairbrother and Heidi Park, both at the New York Academy of Medicine, found that it is often difficult or impossible for community health centers to refer uninsured patients for needed diagnostic, behavioral, or specialty care. A paper⁽³¹⁾ by Emory University researchers Kenneth E. Thorpe and David Howard found systematic evidence that uninsured cancer patients receive less care yet incur much higher out-of-pocket expenses than comparable patients with health insurance.

A study⁽³²⁾ by Carol Pryor and colleagues offered evidence that federal rules may inadvertently encourage aggressive debt collection efforts by hospitals against impoverished patients. After the publication was released, the House Energy and Commerce Committee began to investigate the problem and seek legislative solutions.

Those approaching the age of Medicare eligibility are particularly vulnerable to the consequences of being uninsured. In an article⁽³³⁾ on the use of medical technology for treatment of heart attack, cataracts, and depression among insured and uninsured patients ages 55-64, Sherry Glied and Sarah E. Little documented that underuse of technology results in higher morbidity and mortality in the uninsured. Gaining access to Medicare coverage dramatically improves previously uninsured older adults' use of a range of preventive services, including cholesterol testing, mammography, and prostate exams, according to Fund-supported research published in the Journal of the American Medical Association.⁽³⁴⁾ The findings suggest that if uninsured adults approaching age 65 were able to purchase Medicare coverage affordably, they would likely take advantage of potentially life-saving tests.

Other studies examined the content of insurance and possible expansion strategies for the uninsured, including tax credits. In her analysis of the value of insurance to low-income adults and families, Sherry Glied challenged the assertion that "something is better than nothing." Her findings, published as a book chapter,⁽³⁵⁾ indicate that insurance expansions will fail to meet the needs of people with very limited incomes if coverage depends on high front-end patient cost-sharing. A report⁽³⁶⁾ by Fund staff found that proposed tax credit plans are especially risky for women because they tend, at best, to be sufficient only for plans with high deductibles and that omit such important services as maternity care. In some states, the proposed tax credit is inadequate to buy any individual policy.

The design of employer-sponsored coverage is also of increasing concern. Task Force grantees have followed the progress of a new type of plan, known collectively as "consumer-driven health care" or "defined contribution" plans. The plans take several forms, yet all raise the danger of splitting the risk pool and increasing costs and access barriers to low-income and sicker employees and their families. Employers' participation in the new products has so far been marginal, with just 1.5 million people enrolled by the end of 2002, according to an analysis⁽³⁷⁾ by Jon Gabel, Anthony LoSasso, and Thomas Rice. Current fieldwork is examining the experiences of three employers that adopted the plan designs to gauge the effect on group coverage. A Task Force survey will assess the extent of erosion in private insurance markets.

To reach individual consumers and action groups, the Task Force has supported the enhancement of three insurance-related websites. Access to Health Insurance/Resources for Care⁽³⁸⁾ targets self-employed or part-time workers and provides information on public and private coverage options. In addition, the site alerts readers to important health policy news and provides links to state and national initiatives. The Fund also supported the launch of a new website, healthcarecoach.com,⁽³⁹⁾ by the National Health Law Program, which offers informative articles on insurance coverage for individuals and families. A grant to Georgetown University will enable the Health Policy Institute's healthinsuranceinfo.net⁽⁴⁰⁾ to provide information on legal protections regarding insurance coverage. The Task Force is also supporting work by Karen Pollitz at Georgetown University to work with the American Diabetes Association in developing a manual to help its staff, and staff at other associations of chronically ill patients, respond to insurance concerns.