Given the strong correlation between state rates of uninsured and
lower rates of preventive care, we would expect to find that chronically
uninsured or unstably insured children and adults 11 would lack basic
access to care for extended periods of time, putting them at higher risk
of morbidity and mortality over time. It is not possible, however, to
examine such person-level experiences at the state level with currently
available insurance and care data. With implementation of the PPACA
and its enhanced coverage, we anticipate that there will be improvements
in care and amenable mortality data.
Some have suggested that the poor performance of the US on various
health outcomes relative to other developed countries, for example,
life expectancy, is primarily related to population differences and in
no way or only a small way related to health system performance,
others disagree. Recently, Muennig and Glied, in a study in which
comparative national life expectancies were examined over time in
relation to population risk, have found that ‘the risk profiles of Americans generally improved relative to those for citizens of many
other nations, but Americans’ fifteen-year survival has nevertheless
been declining’.12 They comment that ‘the findings undercut critics
who might argue that the US health-care system is not in need of major
changes, or that changes would not play an important role in improving
US health outcomes’.