ccess to adequate, affordable, and secure health insurance is essential to the U.S. health care system and the nation's economy. Without it, the doors to high-quality medical care will remain closed for many American families, and the possibility of catastrophic medical bills will continue to threaten their economic security.
Despite efforts by the states to expand health coverage incrementally and maintain funding for public insurance programs, the number of uninsured Americans has continued to grow. Forty-five million were without health coverage in 2003, an increase of 5.2 million from 2000. Millions more face the periodic loss of insurance, with as many as one of four Americans under age 65 experiencing a time without coverage during the course of a year. Within the insured population, the ongoing erosion in the quality of coverage—as evidenced by rising deductibles and patient cost-sharing—has led to new concerns about people's ability to pay for needed care even with insurance.
Spurred by growing public concern about the future, comprehensive health reform is once again on the nation's agenda. Restructuring the nation's health insurance system to better meet the needs of American workers and families is central to the mission of The Commonwealth Fund. Three Fund programs focus on improving coverage and access to care:
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