American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534 •

Universal Health Care

All Americans deserve comprehensive health coverage. Unfortunately, a recent report by Families USA, based on Census Bureau data, found that 74.7 million Americans under 65 years of age - almost one out of three (30.1 percent) - were uninsured at some point during 2001-2002. Almost two-thirds (65 percent) of these uninsured people were without health coverage for at least six months, and nearly one-quarter (24 percent) were uninsured throughout the two-year period. Many uninsured workers are low-income part-time/flex-time workers. They usually work for small firms that offered no employer-based health insurance.

The lack of health care coverage is detrimental to the individuals, their families, and the community at large. Due to the high costs of health care, uninsured individuals and their families have difficulties getting quality health care when they are sick. They tend to delay treatments until their illnesses become serious, and are less likely to seek routine preventive health services that can avert or detect major illnesses early on. As a result, they are usually sicker and more likely to die sooner than people with health insurance.

The lack of health insurance aggravates the financial burden of the whole community. Since the uninsured tend to delay necessary treatment, they are often sicker and therefore more expensive to treat when they finally seek care. Also, when they decide to seek care, they frequently turn to the nearest hospital emergency room, which is an expensive and inefficient way to get care. Furthermore, the primary providers of care to the uninsured, such as public hospitals, teaching hospitals, academic health centers, and non-profit community hospitals, incur heavy losses from high rates of uncompensated care. In turn, these providers are forced to cut back on their services to all patients or even close their facilities.

With the current economic downturn, combined with double-digit inflation of health care costs, health insurance is increasingly unaffordable. With significant number of job layoffs, many workers will loss health coverage or be left with few resources to buy coverage on their own. As a result, the number of uninsured Americans is expected to rise.

Suggestions for Improvement

The American Public Health Association supports legislative measures that are congruent with APHA's fourteen principles on universal health care (

APHA advocates the following:

  • Universal coverage for everyone in the United States with comprehensive benefits, affordable prices, and quality services.
  • Organization and administration of health care through publicly-accountable mechanisms to assure maximum responsiveness to public needs, with a major role for federal, state, and local government health agencies.
  • Attention in the organization, staffing, delivery, and payment of care to the needs of all populations including those confronting geographic, physical, cultural, language, and other non-financial barriers to service.

Legislation Supported by APHA

  • H.R. 15, introduced by Representative John Dingell (D-MI), would establish a national health plan that would cover virtually all persons in the U.S. not covered under Medicare.
  • S. 581, introduced by Senators Wyden (D-Ore.) and Hatch (R-Utah) would provide for public discussion and debate on how to best improve our nation's health care system.

Related APHA Policy: 20007, 9502

Updated 4-03