Insuring America's Health: Principles and Recommendations


Report at a Glance

  • Report Brief (PDF)
  • Uninsurance Facts and Figures: Fact Sheet 1 (PDF)
  • Uninsurance Facts and Figures: Fact Sheet 2 (PDF)
  • Uninsurance Facts and Figures: Fact Sheet 3 (PDF)
  • Uninsurance Facts and Figures: Fact Sheet 4 (PDF)
  • Uninsurance Facts and Figures: Fact Sheet 5 (PDF)

Note: In the 2009 report America's Uninsured Crisis: Consequences for Health and Health Care, the IOM provides an updated review of the research evidence on three questions: (1) What are the dynamics driving downward trends in health insurance coverage? (2) Is being uninsured harmful to the health of children and adults? (3) Are insured people affected by high rates of uninsurance in their communities?

Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage. To help policy-makers, elected officials, and others judge and compare proposals to extend coverage to the nation's 43 million uninsured, the Institute of Medicine of the National Academies offers a set of guiding principles and a checklist in a new report, Insuring America's Health: Principles and Recommendations.

The report is the culmination of a series that offers the most comprehensive examination to date of the consequences of lack of health insurance on individuals, their families, communities and the whole society. The report also demonstrates how the principles can be used to assess policy options. The IOM Committee does not recommend a specific coverage strategy. Rather, it shows how various approaches could extend coverage and achieve certain of the Committee's principles.

The committee proposes a clear and compelling overall recommendation that by 2010 everyone in the United States should have health insurance and urges the president and Congress to act immediately by establishing a firm and explicit plan to reach this goal. The committee envisions an approach that will promote better overall health for individuals, families, communities, and the nation by providing financial access for everyone to necessary, appropriate, and effective health services.

In Insuring America's Health: Principles and Recommendations, the committee offers a set of guiding principles, based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance., for analyzing the pros and cons of different approaches to providing coverage. The principles for guiding the debate and evaluating various strategies are:

  1. Health care coverage should be universal.
  2. Health care coverage should be continuous.
  3. Health care coverage should be affordable to individuals and families.
  4. The health insurance strategy should be affordable and sustainable for society.
  5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

Although all the principles are necessary, the first is the most basic and important. The principles are intentionally general, which allows them to be applied in more specific operational and political processes. A fact sheet on each of these principles and a checklist of questions based on the principles are available below.