Harvard Policy Papers Detail the Growing Problem of Americans Without Health Insurance - And Make Recommendations for Change

Developing policy analysis white papers on the uninsured

Between 1999 and 2001, the Harvard School of Public Health, Boston, researched a series of briefing papers examining the characteristics of the uninsured.

Key Findings

  • For the first paper, "Americans Without Insurance Coverage in 1999," the principal investigator, Katherine Swartz, analyzed data from the federal government's Current Population Survey and found:

    • The number of Americans who did not have health insurance was 44.3 million in March 1999, an increase of 800,000 from March 1998.
    • Children, young adults and near-retirees (those ages 55 to 64) were among the age groups with the largest increases in the numbers of uninsured.
    • While more than half (50.5%) of the uninsured had family incomes below $25,000, 21 percent lived in households with incomes above $50,000.
    • People of color are significantly more likely than whites to be uninsured.
    • More than 60 percent of the uninsured are working. Of these, 32.8 percent work in firms with fewer than 10 people.
  • In the second paper, "Health Insurance Coverage of People in the Ten Years Before Medicare Eligibility," Swartz examines the health insurance status of "near retirees"—people 55 to 64 years old—and discusses the impact of raising Medicare eligibility to age 67.

  • The third paper "Restructuring Health Insurance and Health Insurance Markets to Cover the Uninsured," recommends that employers and individuals should be encouraged to adopt indemnity policies that do not provide "first-dollar" coverage but instead offer coverage for "catastrophic" medical events.

    The principal investigator suggests that these policies, featuring high deductibles and co-payments, represent one way to reduce premiums and expand coverage to the uninsured.