Author Affiliations: Dr Rennie (email@example.com) is Deputy Editor and Dr Fontanarosa is Executive Deputy Editor, JAMA.
The number of individuals in the United States who are unable to access medical care because they are underinsured or lack any insurance at all continues to increase. An estimated 61 million persons aged 19 to 64 years were uninsured or underinsured in 2003.1 The peculiarly US system of basing insurance on employment is collapsing in the face of businesses that are no longer making this same commitment to their employees. A recent analysis2 based on data from the 2001 Medical Expenditure Panel Survey found that 22 million of 112.8 million individuals who are working in the United States were not offered health insurance, and 56% of employees in firms with fewer than 25 employees had employer-based coverage. Another recent report3 indicates that the number of uninsured US citizens increased by 6 million between 2000 and 2004, with this increase primarily due to declines in employer coverage, and suggests that this trend is likely to worsen given the continued increases in health care costs and health insurance premiums. Estimates of the number of citizens who will lose their coverage when Medicaid recipients have to produce proof of citizenship after June 30, 2006, are debated, but the change in the law is predicted to add to the rolls of the uninsured.4
Rennie D, Fontanarosa PB. Theme Issue on Access to Health CareCall for Papers. JAMA. 2006;295(18):2182-2183. doi:10.1001/jama.295.18.2182