[Congressional Record Volume 142, Number 137 (Saturday, September 28, 1996)]
[Extensions of Remarks]
[Page E1801]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              LACK OF HEALTH INSURANCE--HIGHER DEATH RATE

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Friday, September 27, 1996

  Mr. STARK. Mr. Speaker, health insurance for everyone isn't just a 
nice idea, it is a matter of life and death. The data is clear. In 
1982, the State of California terminated Medi-Cal benefits for the 
State's 270,00 medically indigent adults. Some 186 of these adults were 
then enrolled in a study to examine the effects of this action on the 
health of these individuals. A comparison group was also established. 
Within 6 months of termination of health coverage, five individuals 
died compared to zero deaths for the comparison group. After 1 year of 
the study, seven individuals from the group whose Medi-Cal benefits had 
been terminated had died compared to one death in the comparison group.
  Investigation of the circumstances of death suggest that lack of 
access to care played a part in at least four of the deaths in the 
medically indigent group. At least four deaths that could have been 
prevented if these individuals had health insurance. And now this 
Congress is preparing to adjourn without having adequately addressed 
one of the greatest problems facing our Nation: the lack of health 
insurance for everyone. How many more people will have to die before we 
decide to commit ourselves to this problem and find a solution?
  Another study used data from 17 hospitals to examine outcomes for 
patients admitted with pneumonia. Self-pay patients were six times more 
likely to die with in the hospital compared to those with insurance. A 
national study determined that the probability of an in-hospital death 
for uninsured patients was 1.08 to 1.32 times higher than for privately 
insured patients in 15 of 16 age-sex-rate cohorts.
  In another study, a representative cohort of the U.S. population was 
followed for up to 16 years. The study hypothesis in this case was that 
a lack of health insurance is causally related to a higher mortality 
rate, because of decreased access and lower quality of care. Not only 
is this hypothesis in accordance with the results of previous studies, 
but it also agrees with the conclusions of our own former Office of 
Technology Assessment in a report issued in 1992.
  Furthermore, the study found that lacking insurance is associated 
with subsequent higher mortality independent of our risk factors.


                   independent of other risk factors

  In one of the same studies mentioned above, fully 68 percent of the 
study's participants in the medically indigent group reported a 
specific episode in which they had not obtained care that they believed 
they needed; of those patients, 78 percent listed the cost as a reason 
for not obtaining care. We cannot let this problem escalate into a 
national tragedy of even greater proportions.
  The numbers are alarming. The evidence is clear. As members of a 
civilized society, I would hope that the next Congress has the courage 
to deal with this issue.
  For those who share my concerns, I invite you to reference the 
following sources:
  (1) Lurie, N., Ward, N.B., Shapiro, M.F., Brook, R.H., ``Termination 
from Medi-Cal: does it affect health?'' N Engl J Med. 1984; 311: 480-
484.
  (2) Lurie, N., Ward, N.B., Shapiro, M.F., Gallego, C., Vaghaiwalla, 
R., Brook, R.H., ``Termination of medical benefits: a follow-up study 
one year later.'' N Engl J Med. 1986; 314: 1266-1268.
  (3) Weissman, J.S., Epstein, A.M., ``Falling Through the Safety Net: 
The Impact of Insurance on Access to Care.'' Baltimore, Md: Johns 
Hopkins University Press; 1994.
  (4) Franks, P., Clancy, C.M., Gold, M.R., ``Health insurance and 
mortality: evidence from a national cohort,'' JAMA. 1993; 270: 737-741.

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