Executive Summary
Improving Health Services Research on Uninsurance and Underinsurance
One of the dominant health policy issues over the past three decades has been expanding
access to health insurance for non-elderly Americans. As of March, 2008, there were 47
million uninsured Americans, and millions more are identified as “underinsured.” In this
essay, I address the key research questions surrounding access to health care for the
uninsured and underinsured. The first is developing a richer understanding of why
individuals are uninsured: how do we define the level at which the uninsured can afford
insurance, and how do we separate affordability from other reasons for a lack of
insurance coverage. The second is a broad understanding of the personal and social
implications of uninsurance, moving beyond health outcomes to look at measures of
psychological and financial stress and social implications through the labor market. The
third is defining and understanding the implications of “underinsurance,” particularly
relative to the problem of the uninsured. Finally, in the last section I tackle the issue of
how to improve research in these areas to address these important unanswered questions.