1
Figure 1. We Can’t Continue on Our Current Path:
Growth in the Uninsured
Uninsured Projected to Rise
to 61 million by 2020
45.7 Million Uninsured, 2007
Millions uninsured
Military
(1%)
Uninsured
(15%)
70
Employer
(55%)
60
50
Individual
(5%)
40
40 38
Medicaid
(10%)
30
45
42 43 43
47 46 47 48
49
53
50 52
55 56
59
57 58
60 61
20
10
Medicare
(13%)
0
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Total population
Projected estimates
Data: Analysis of the U.S. Census Bureau, Current Population Survey Annual Social and Economic Supplement
(CPS ASEC), 2001–2008; projections to 2020 based on estimates by The Lewin Group.
THE
COMMONWEALTH
FUND
Figure 2. 75 Million People Were Uninsured for All or Part of the
Year Before the Start of the Recession
Uninsured
All Year
38m
13%
2
Uninsured
All Year
37m
14%
Uninsured
Part Year
37m
12%
Uninsured
Part Year
34m
13%
Insured All Year
224m
75%
Total Population = 299 million
Insured All Year
189m
73%
Under-65 Population = 260 million
Source: Analysis of the 2006 of the Medical Expenditure Panel Survey by B. Mahato of Columbia University for The
Commonwealth Fund.
THE
COMMONWEALTH
FUND
3
Figure 3. Uninsured Rates High Among Adults
with Low and Moderate Incomes, 2001–2007
Percent of adults ages 19–64
75
Insured now, time uninsured in past year
Uninsured now
50
25
24
9
15
49
50
16
15
41
28
28
10
11
33
35
18
17
16
18
24
0
Total
Low
income
Moderate
income
13
7
6
11
4
7
Middle
income
3
1
8
3
5
High
income
Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–$34,999, middle income is
$35,000–$59,999, and high income is $60,000 or more. In 2005 and 2007, low income is <$20,000, moderate income is $20,000–$39,999,
middle income is $40,000–$59,999, and high income is $60,000 or more. Subgroups may not sum to totals because of rounding.
Source: S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health Insurance Is Burdening
Working Families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007 (New York: The Commonwealth
Fund, August 2008).
THE
COMMONWEALTH
FUND
Figure 4. The Majority of U.S. Workers Get Their
Health Insurance Through Employers, 2007
4
Uninsured
(14%)
Other coverage*
(9%)
Public programs
(5%)
Own employer
coverage
(56%)
Other employer
coverage
(16%)
122.2 Million Full- and Part-Time Workers Ages 19–64
*Includes those with individual insurance and “other” responses.
Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small
Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the
Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data:
The Commonwealth Fund Biennial Health Insurance Survey (2007).
THE
COMMONWEALTH
FUND
Figure 5. 2009 Changes in Coverage at Different Levels of
Unemployment (Base of 4.6% in 2007)
5
Millions of People
ESI
Medicaid/SCHIP
Uninsured
10
5
3.4 3.7
2.4 2.6
5.4 5.8
4.4 4.8
0
-5
-5.9
-8.3
-10
-10.7
-13.2
-15
7% Unemployment
8% Unemployment
9% Unemployment
10% Unemployment
Source: J. Holahan and A.B. Garrett, Rising Unemployment, Medicaid, and the Uninsured, Publication No. 7850
(Washington: Kaiser Commission on Medicaid and the Uninsured, January 2009).
THE
COMMONWEALTH
FUND
Figure 6. Employer Coverage Continues to Be Major Source of Coverage
for Employees of Larger Firms But Has Declined Among Small Firms
6
Percent of firms offering health benefits
2000
2008
100
91
80
75
69
63
97
90
99
94
99
78
57
49
50
25
0
Total
3–9 workers
10–24
workers
25–49
workers
50–199
workers
200+ workers
Source: The Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2000 and
2008 Annual Surveys.
THE
COMMONWEALTH
FUND
Figure 7. Employer-Sponsored Insurance Coverage Declined
Among Small Firm Employees, 2003–2007
7
Percent of working adults ages 19–64*
100
Employer Insurance - other
Employer Insurance - own
84
14
75
85
12
57
50
49
22
24
70
74
2003
2007
25
35
25
0
2003
2007
Small Firms
(fewer than 50 employees)
Large Firms
(50 or more employees)
*Includes both part-time and full-time workers.
Note: Subgroups may not sum to totals due to rounding.
Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable
Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The
Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2003 and 2007).
THE
COMMONWEALTH
FUND
Figure 8. Low-Wage Employees in Small Firms
Are Less Likely to Have Employer-Sponsored Insurance Coverage
8
Percent of working adults ages 19–64*
100
Employer Insurance - other
94
85
11
Employer Insurance - own
12
75
68
62
13
50
49
38
30
24
55
22
25
25
83
74
32
16
0
Total
<$15/hr
$20/hr or
more
Small Firms
(fewer than 50 employees)
Total
<$15/hr
$20/hr or
more
Large Firms
(50 or more employees)
*Includes both part-time and full-time workers.
Note: Subgroups may not sum to totals due to rounding.
Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable
Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The
Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
THE
COMMONWEALTH
FUND
9
Figure 9. Percent of Adults Ages 18–64 Uninsured by State
1999–2000
2006–2007
WA
VT
NH ME
NH
WA
ND
MT
VT
MT
MN
OR
ID
NY
WI
SD
MI
WY
PA
IA
NE
CA
OH
IN
NV
UT
IL
CO
MA
KS
MO
WV
VA
KY
NJ
RI
CT
MN
OR
ID
MI
PA
IA
NE
CA
IL
CO
KS
MO
AZ
NM
MS
TX
AL
DE
MD
DC
NC
AZ
GA
OK
NM
SC
AR
MS
LA
TX
AL
GA
LA
FL
AK
VA
NJ
RI
CT
TN
SC
AR
WV
KY
TN
OK
OH
IN
NV
UT
MA
NY
WI
SD
WY
DE
MD
DC
NC
ME
ND
FL
AK
HI
23% or more
HI
19%–22.9%
14%–18.9%
Less than 14%
Data: Two-year averages from the U.S. Census Bureau, CPS ASEC, 2000–2001 and 2007–2008;
1999–2000 estimates updated with 2007 CPS correction.
THE
COMMONWEALTH
FUND
Figure 10. 25 Million Adults Underinsured in 2007
60 Percent Increase Since 2003
Uninsured
during the year
45.5
(26%)
Insured all year,
not
underinsured
110.9
(65%)
Uninsured
during the year
49.5
(28%)
10
Insured all year,
not
underinsured
102.3
(58%)
Insured
all year,
underinsured*
25.2
(14%)
Insured
all year,
underinsured*
15.6
(9%)
2003
2007
Adults ages 19–64
(172.0 million)
Adults ages 19–64
(177.0 million)
*Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or
more of income; medical expenses equaled 5% or more of income if low-income (<200% of poverty); or deductibles
equaled 5% or more of income.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2003 and 2007).
Source: C. Schoen, S. R. Collins, J. L. Kriss, and M. M. Doty, “How Many Are Underinsured? Trends Among U.S.
Adults, 2003 and 2007,” Health Affairs Web Exclusive, June 10, 2008.
THE
COMMONWEALTH
FUND
Figure 11. Two of Five Adults Uninsured or Underinsured;
Percent Underinsured Triples for Middle-Income
11
Percent of adults (ages 19–64) who are uninsured or underinsured
100
Underinsured*
Uninsured during year
75
68
19
50
72
24
42
35
14
9
25
27
49
48
11
4
28
26
17
13
16
2003
2007
0
2003
Total
2007
2003
2007
Under 200% of poverty
200% of poverty or more
*Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more
of income, or 5% or more of income if low-income (<200% of poverty); or deductibles equaled 5% or more of income.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2003 and 2007).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
THE
COMMONWEALTH
FUND
Figure 12. Over Half of Working Adults in Small Firms Were
Uninsured or Underinsured During the Year, 2007
Adequately insured
48%
Uninsured anytime
36%
12
Uninsured anytime
15%
Underinsured
13%
Underinsured
16%
Firms with fewer than 50 employees
39.0 million
Adequately
insured
73%
Firms with 50 or more employees
76.9 million
^Includes both part-time and full-time workers.
Underinsured is defined as having continuous health insurance coverage and spending 10 percent or more of income on out-of-pocket health
care costs (or 5 percent or more if low income), or having deductibles of 5 percent or more of income.
Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small Businesses Lack Affordable
Health Insurance and How Health Care Reform Can Help: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007, The
Commonwealth Fund, September 9, 2009. Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
THE
COMMONWEALTH
FUND
13
Figure 13. Deductibles Rise Sharply,
Especially in Small Firms, 2000–2008
Mean deductible for single coverage (PPO, in-network)
2000
$1,000
2008
917
$750
560
$500
$250
413
187
210
157
$0
Total
Small firms, 3–199
employees
Large firms, 200+
employees
PPO = preferred provider organization. PPOs covered 57 percent of workers enrolled in an employer-sponsored
health insurance plan in 2007.
Source: The Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2000 and
2008 Annual Surveys.
THE
COMMONWEALTH
FUND
Figure 14. Insurance Benefits Are Not As Generous
for Workers in Small Businesses
14
Percent of working adults ages 19–64 with own employer-sponsored insurance*
<50 employees
50+ employees
75
50
48
37
23
25
16
9
3
0
Coverage limits total amount it
will pay for medical care
No prescription
drug coverage
Fair or poor rating of
insurance plan
*Includes both part-time and full-time workers.
Source: M. M. Doty, S.R. Collins, S.D. Rustgi, and J.L. Nicholson, Out of Options: Why So Many Workers in Small
THE
COMMONWEALTH
Businesses Lack Affordable Health Insurance and How Health Care Reform Can Help: Findings from the
FUND
Commonwealth Fund Biennial Health Insurance Survey, 2007, The Commonwealth Fund, September 9, 2009. Data: The
Commonwealth Fund Biennial Health Insurance Survey (2007).
Figure 15. Underinsured and Uninsured Adults at High Risk of
Going Without Needed Care and Financial Stress
15
Percent of adults (ages 19–64)
Insured, not underinsured
75
Underinsured
Uninsured during year
68
53
51
45
50
31
21
25
0
Went without needed care due to costs*
Have medical bill problem or outstanding
debt**
*Did not fill prescription; skipped recommended medical test, treatment, or follow-up, had a medical problem but did
not visit doctor; or did not get needed specialist care because of costs. **Had problems paying medical bills;
changed way of life to pay medical bills; or contacted by a collection agency for inability to pay medical bills.
Source: C. Schoen, S. Collins, J. Kriss, M. Doty, How Many are Underinsured? Trends Among U.S. Adults, 2003 and
2007, Health Affairs Web Exclusive, June 10, 2008. Data: 2007 Commonwealth Fund Biennial Health Insurance
Survey.
THE
COMMONWEALTH
FUND
Figure 16. Uninsured and Underinsured Adults with Chronic
Conditions Are More Likely to Visit the ER for Their Conditions
16
Total
Percent of adults ages 19–64 with
at least one chronic condition*
Insured all year, not underinsured
Insured all year, underinsured
Insured now, time uninsured in past year
75
Uninsured now
62
50
64
46
43
33
32
33
26
25
15
19
0
Skipped doses or did not fill prescription for
chronic condition because of cost**
Visited ER, hospital, or both for chronic
condition
*Hypertension, high blood pressure; heart disease; diabetes; asthma, emphysema, or lung disease.
**Adults with at least one chronic condition who take prescription medications on a regular basis.
Data: The Commonwealth Fund Biennial Health Insurance Survey (2007).
Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health
Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
THE
COMMONWEALTH
FUND
17
Figure 17. Lack of Insurance Undermines
Preventive and Chronic Care
Chronic Disease Under Control:
Diabetes and Hypertension, 1999–2004
Receipt of Recommended Screening and
Preventive Care*, 2005
Percent of adults
100
Insured
100
Uninsured
81
80
80
63
60
53
50
60
46
41
40
32
40
21
20
20
0
Total
Uninsured
all year
Uninsured
part year
Insured all
year
0
Diabetes under control**
High blood pressure
under control***
*Recommended care includes: blood pressure, cholesterol, Pap, mammogram, fecal occult blood test or
sigmoidoscopy/colonoscopy, and flu shot within a specific time frame given age and sex. **Refers to diabetic adults
whose HbA1c is <9.0 ***Refers to hypertensive adults whose blood pressure is <140/90 mmHg.
THE
COMMONWEALTH
Data: Preventive care–B. Mahato, Columbia University analysis of Medical Expenditure Panel Survey; Chronic
FUND
disease–J. M. McWilliams, Harvard Medical School analysis of National Health and Nutrition Examination Survey.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
Figure 18. Uninsured Adults and Adults with Gaps in Coverage
Have Lower Rates of Cancer Screening Tests, 2007
18
Total
Percent of adults ages 19–64
Insured all year
Insured now, time uninsured in past year
100
Uninsured now
84
80
60
78
81
77
74
54
51
60
56
36
35
40
22
20
0
Received Pap test
Received colon cancer
screening
Received mammogram
Note: Pap test in past year for females ages 19–29, past three years age 30+; colon cancer screening in past five years
for adults ages 50–64; and mammogram in past two years for females ages 50–64.
Source: S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health
Insurance Is Burdening Working Families: Findings from the Commonwealth Fund Biennial Health Insurance Surveys,
2001–2007, The Commonwealth Fund, August 2008.
THE
COMMONWEALTH
FUND
19
Figure 19. Cost-Related Problems Getting Needed Care
Have Increased Across All Income Groups, 2001–2007
Percent of adults ages 19–64 who had any of four access problems*
in past year because of cost
2001
75
62
50
58
45
41
2007
43
40
29
29
24
25
14
0
Total
Low income
Moderate
income
Middle income
High income
*Did not fill a prescription; did not see a specialist when needed; skipped recommended medical test, treatment, or
follow-up; had a medical problem but did not visit doctor or clinic.
Note: In 2001, low income is <$20,000, moderate income is $20,000–$34,999, middle income is $35,000–$59,999, and
high income is $60,000+. In 2007, low income is <$20,000, moderate income is $20,000–$39,999, middle income is
$40,000–$59,999, and high income is $60,000+.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2007).
Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health
Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
THE
COMMONWEALTH
FUND
20
Figure 20. Problems with Medical Bills or
Accrued Medical Debt Increased, 2005–2007
Percent of adults ages 19–64 with medical bill problems or
accrued medical debt
2005
75
2007
56
53
48
50
41
43
39
34
32
25
25
20
0
Total
Low income
Moderate
income
Middle income
High income
Note: Low income is <$20,000, moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high
income is $60,000+.
Data: The Commonwealth Fund Biennial Health Insurance Surveys (2005 and 2007).
Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health
Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
THE
COMMONWEALTH
FUND
21
Figure 21. Medical Bill Problems and
Accrued Medical Debt, 2005–2007
Percent of adults ages 19–64
2005
2007
Had problems paying or unable to pay medical bills
23%
39 million
27%
48 million
Contacted by collection agency for
unpaid medical bills
13%
22 million
16%
28 million
Had to change way of life to pay bills
14%
24 million
18%
32 million
Any of the above bill problems
28%
48 million
33%
59 million
Medical bills being paid off over time
21%
37 million
28%
49 million
Any bill problems or medical debt
34%
58 million
41%
72 million
In the past 12 months:
Source: S. R. Collins, J. L. Kriss, M. M. Doty and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health
Insurance Is Burdening Working Families, The Commonwealth Fund, August 2008.
THE
COMMONWEALTH
FUND
22
Figure 22. More Than One-Quarter of Adults
Under Age 65 With Medical Bill Burdens and Debt
Were Unable to Pay for Basic Necessities
Percent of adults ages 19–64 with medical bill problems
or accrued medical debt
Uninsured Anytime
During Year
Insured All Year
Underinsured
Insured now, time
uninsured in past
year
Uninsured
now
16%
29%
42%
40%
39
26
46
46
47
Took out a mortgage against
your home or took out a loan
10
9
12
11
11
Took on credit card debt
30
28
33
34
26
Insured at time care was
provided
61
80
82
46
24
Total
No underinsured
indicators
29%
Used up all of savings
Percent of adults reporting:
Unable to pay for basic
necessities (food, heat, or rent)
because of medical bills
Source: M. M. Doty, S. R. Collins, S. D. Rustgi, and J. L. Kriss, Seeing Red: The Growing Burden of Medical Bills and
Debt Faced by U.S. Families, The Commonwealth Fund, August 2008.
THE
COMMONWEALTH
FUND
23
Figure 23. An Estimated 116 Million Adults Were Uninsured, Underinsured,
Reported a Medical Bill Problem, and/or Did Not Access Needed Health
Care Because of Cost, 2007
Medical bill/ debt
problem
17.7 million
10%
Adequate coverage
and no bill or access
problem
61.4 million
35%
Uninsured anytime
during the year or
underinsured
17.6 million
10%
Medical bill/debt and costrelated access problem
54.4 million
31%
Cost-related
access problem
25.9 million
15%
177 million adults, ages 19–64
Source: S. R. Collins, J. L. Kriss, M. M. Doty, and S. D. Rustgi, Losing Ground: How the Loss of Adequate Health
Insurance Is Burdening Working Families: Findings from the Commonwealth Fund Biennial Health Insurance
Surveys, 2001–2007, The Commonwealth Fund, August 2008. The Commonwealth Fund Biennial Health Insurance
Survey (2007).
THE
COMMONWEALTH
FUND
24
Figure 24. CHIP Has Reduced Rates of Uninsured Children in Most States
Percent of Children Ages 0–17 Uninsured by State
1999–2000
2005–2006
WA
VT
NH ME
NH
WA
ND
MT
VT
MT
MN
OR
ID
NY
WI
SD
MI
WY
PA
IA
NE
CA
OH
IN
NV
UT
IL
CO
MA
KS
MO
WV
VA
KY
NJ
RI
CT
MN
OR
ID
MI
PA
IA
NE
CA
IL
CO
KS
MO
AZ
NM
MS
TX
AL
DE
MD
DC
NC
AZ
GA
NM
OK
SC
AR
MS
LA
TX
AL
GA
LA
FL
AK
VA
NJ
RI
CT
TN
SC
AR
WV
KY
TN
OK
OH
IN
NV
UT
MA
NY
WI
SD
WY
DE
MD
DC
NC
ME
ND
FL
AK
HI
16% or more
HI
10%–15.9%
7%–9.9%
Less than 7%
THE
Data: Two-year averages 1999–2000, updated with 2007 Current Population Survey correction, and 2005–2006 from theCOMMONWEALTH
FUND
Census Bureau’s March 2000, 2001 and 2006, 2007 CPS.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
24
Figure 25. Low-Income Workers Are Eligible for COBRA at Only
Half the Rate of Higher-Income Workers
Ineligible, smallfirm worker
3%
Ineligible,
uninsured
33%
COBRA-eligible
38%
25
Ineligible,
smallfirm worker
Ineligible,
6%
uninsured
7%
Ineligible, insured
but not through
employer
11%
COBRA-eligible
76%
Ineligible, insured
but not through
employer
27%
Below 200% FPL
200%+ FPL
Source: M. Broaddus et al., Measures in House Recovery Package—But Not Senate Package—Would Help
Unemployed Parents Receive Health Coverage (Washington, D.C.: Center on Budget and Policy Priorities, February
2009); M. M. Doty et al., Maintaining Health Insurance During a Recession: Likely COBRA Eligibility (New York: The
Commonwealth Fund, January 2009).
THE
COMMONWEALTH
FUND
Figure 26. Even With ARRA Subsidies, COBRA Still Unaffordable
for Individuals and Families at 150 Percent of Poverty
Full COBRA Premium
Unsubsidized Amount
$14,000
26
10% Income
$12,680
$12,000
$10,000
$8,000
$6,000
$4,704
$4,438
$4,000
$2,000
$2,640
$1,646
$1,560
$0
Individual
Family
Source: M. Broaddus et al., Measures in House Recovery Package—But Not Senate Package—Would Help
Unemployed Parents Receive Health Coverage (Washington: Center on Budget and Policy Priorities, February
2009).
THE
COMMONWEALTH
FUND
27
Figure 27. Average Family Premium as a Percentage
of Median Family Income, 1999–2020
25%
20%
17%
16%
21%
20%
20%
19% 19%
18% 18%18%19%
18%
18%
22%
21%
23%
22%
24%
14%
15%
13%
12%
11%
10%
5%
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0%
Projected
Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, The
Commonwealth Fund, August 2009.
THE
COMMONWEALTH
FUND
Figure 28. Average Annual Savings per Family
Under Health Reform That Controls Premium Growth, 2020
28
Savings in health care spending compared with projected trends
$3,500
$2,961
$3,000
$2,559
$2,500
$2,314
$2,426
$2,612 $2,624
$2,103 $2,202
$1,857
$2,000
$1,547
$1,500
$1,000
$500
Family Income ($ thousands)
Data: Estimates by The Lewin Group for The Commonwealth Fund.
Source: The Commonwealth Fund Commission on a High Performance Health System, The Path to a
High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way (New York:
The Commonwealth Fund, February 2009).
15
0+
15
0
10
0–
00
75
–1
5
50
–7
0
40
–5
0
30
–4
0
20
–3
0
10
–2
<1
0
Al
l
$0
THE
COMMONWEALTH
FUND