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Report: Areas With High Rates of Uninsurance Have 'Spillover Effect' on Insured Communities

By Stacey Skotzko, CQ Staff

Living in a community with high rates of uninsured individuals could be detrimental to the financial and physical well-being of even those with health insurance, according to a new Institute of Medicine (IOM) report issued Tuesday.

The report found that health care providers and physicians, as well as the latest medical technologies, are often found in more affluent, insured areas. In addition, insured individuals are more likely to have difficulty getting care and to be less satisfied with the care they receive because of local high rates of uninsurance, the report found.

Report committee member Christine Ferguson, a research professor at George Washington University, called the findings some of the most "alarming" in the report, which is a review of a six-part series IOM published from 2000 to 2004 on the impact a lack of health insurance has on children, adults, families and communities.

"Of all the things in the report that it is clear we need to keep a very close eye on, this is the one area," Ferguson said.

The report found that some areas with high rates of uninsurance have problems in specialty care and health care delivery, namely limits on inpatient bed capacity, timeliness of trauma care and outpatient emergency services. In these areas, physicians also may believe they cannot make clinical decisions in the best interest of their patients without losing income, the report says.

"Lacking health insurance is hazardous to your health," said Harvey Fineberg, president of the IOM. " . . . If you lack insurance, you suffer the consequences and your family suffers the consequences and your community suffers the consequences."

Kathleen Stoll, deputy executive director at Families USA, noted the financial impact the uninsured have on the population. According to a previous Families USA study, privately insured families paid, on average, $922 more in 2005 because of health care costs for the uninsured, Stoll said.

"The big takeaway is that we all have a stake, whether we have insurance or not," she said.

The report, sponsored by the Robert Wood Johnson Foundation, also found that changes in employer-based insurance are driving many to do without health coverage. Report committee Chairman Lawrence Lewin, a health policy consultant, said there has been both a reduction in employers offering insurance and employees deciding to take the insurance up, mainly due to the high cost of premiums. Lewin added that even the expansion of public health insurance is in "jeopardy" because of the current fiscal climate in many states.

The report "makes clear that health reform is as much about protecting the health of people who have health coverage today as it is about covering the millions of Americans who are uninsured," House Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., in a statement.

"Until we have a health system that covers everyone, we will exacerbate disparities in access to medical treatment around our country. We need to reform our health system for the health of us all," Stark said.

Obama wants to put the pay-as-you-go rules into law and has a goal of reducing the deficit to $533 billion in fiscal year 2013, according to an administration official.

Vice President Joseph R. Biden Jr. opened the summit by saying it would "begin to tackle the challenges of our nation's long-term fiscal situation."

"The problem will not be solved overnight, that's not news to anyone in this room," he said.

Other keynote speakers stressed what they called the crucial importance of getting health care costs under control, noting that they are driving up expenditures for entitlement programs like Medicare and Medicaid.

"The path to fiscal responsibility must run directly through health care," said White House budget director Peter R. Orszag.

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