DAY SIXTY-TWO: Lack of Health Insurance Sixth-leading cause of death 

(NASHVILLE, August 20, 2005) Adults without health insurance coverage experience greater declines in health status and die sooner than do adults with continuous coverage.^[1] Lack of health insurance coverage is the sixth-leading cause of death for adults between the ages of 25 to 64 – after cancer, heart disease, injuries, suicide, and cerebrovascular disease, but before HIV/AIDS or diabetes.^[2] 

A Special Bulletin, published by UT, The Center for Health Services Research, in March 2002 states, “In some cases lack of insurance leads to premature death … Removing Tennesseans from the TennCare rolls will lead to a greater number of uninsured in Tennessee and … will lead to increased mortality in this population … (and) if the person removed from TennCare were to have more chronic illnesses, the number of additional deaths would be expected to be higher than estimated here.”^[3] 

Based on these studies, it can be estimated that a person will likely die every 20 hours if 323,000 adults are removed from TennCare. 

On March 22, 2004, advocates asked: What were the medical diagnoses of the 15% of TennCare enrollees who accounted for over 75 percent of medical expenses in the representative sample of medical claims on which the McKinsey Report analysis was based (Part I, p. 7)? 

On March 24, the administration answered: The vast majority of the high spend group had multiple diagnoses (75% had more than 5), so there is no one answer or diagnosis classification in most cases. The top disease states in this population (from high-to-low based on total dollar spend) were circulatory, injury, neoplasm, respiratory, musculoskeletal, digestive and genitourinary.^[4]

Deaths of Adults Ages 25 - 64, 1999
Cancer - 156,485 
Heart disease - 115,827 
Injuries - 46,045 
Suicide - 19,549 
Cerebrovascular disease - 18,369 
Uninsured - 18,000 
Diabetes - 16,156 
Respiratory disease - 15,809 
Chronic liver disease and cirrhosis - 15,714 
HIV/AIDS - 14,017 

Sources: U.S. Department of Health and Human Services, National Center for Health Statistics, Health, United States, 2002, Table 33. p. 132 - deaths for causes other than uninsured; Institute of Medicine, Care Without Coverage, Appendix D, p. 162, deaths attributable to higher risks of uninsured adults 25-54.

[1] Institute of Medicine, Care without Coverage: Too Little, Too Late. The National Academies Press: Washington, DC. 2002. http://www.rwjf.org/research/researchdetail.jsp?id=1041&ia=132 

[2] Davis,K., Time for Change: The hidden cost of a fragmented health insurance system, Testimony before the Senate Special Committee on Aging, March 10, 2003. http://www.cmwf.org/publications/publications_show.htm?doc_id=221616 

[3] Waters,T., Ph.D., The Impact of Reducing TennCare Enrollment on Mortality Rates, UT Center for Health Service Research, Special Bulletin: No.4 : March 2002. http://www.utmem.edu/CENTER/Publications/special_bulletin/TennCare%20Deaths.pdf

[4] Chapman, D., Memorandum to Tony Garr. March 24, 2004.

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