When General Assistance Medical Care (GAMC) ends in July of 2010, approximately 36,000 Minnesotans will join the ranks of the uninsured. While much has been said about what this might mean for Minnesota's safety net hospitals and clinics as the number of uninsured Minnesotans swells to more than 400,000 people still needing health care, not enough has been said about the health diagnosis for those who find themselves uninsured.

The loss of insurance does not merely cause patients to experience the inconvenience of longer lines in public hospitals or community-clinic waiting rooms to see a doctor. No! Lack of insurance is a real disease and, as it turns out, a potentially fatal one.

The uninsured are a well-studied but misunderstood group. In the United States there are an estimated 47 million uninsured and, contrary to common belief, undocumented or newly arrived immigrants compose only a small fraction of this number. The uninsured are not elderly; typically they are under the age of 40. More than 80 percent of the uninsured are from working families, and 20 percent — or nearly 8.7 million of the uninsured — are children.

Much has been written about the increasing number of uninsured, their demographics, the reasons for uninsurance and the cost of providing universal coverage. Little has been published about the health consequences of being uninsured. It's a fact that uninsured people are sicker, span a wide range of ages under 65, have worse health status and die younger. 

Lack of insurance leads to excess death rate
The prestigious Institute of Medicine, in its landmark 2002 report, estimated that 18,000 United States residents die each year because they lack insurance. Two longitudinal studies cited in the report estimate the uninsured have a 25 percent higher risk of death and are 3.2 times more likely to die in the hospital than the insured. This excess death rate does not respect gender, age or disease state.

Uninsured women with breast cancer have a 35-57 percent higher adjusted risk of death compared to insured women. Uninsured pregnant women have a 31 percent higher chance of an adverse hospital outcome, including infant death after giving birth. Uninsured diabetics are 11 times more likely to experience avoidable hospitalization.

A 2004 study from the Harvard Medical School faculty estimated the risk of death in the uninsured "near elderly" is a risk-adjusted 43 percent higher than age-matched insured; they have a 53 percent increase in premature deaths. This results in more than 100,000 premature excess deaths over an eight-year period in the 50-64 age group alone, attributable solely to lack of health insurance. Not surprisingly, patients with high blood pressure, diabetes, or heart disease were most affected.

The excess mortality seen in the uninsured is not only due to lack of screening, patient inability to afford prescription drugs or ability or lack of willingness to seek preventive care. A 2003 study from the Massachusetts Institute of Technology looked at an unplanned medical event: auto accidents. This study amazingly found that the uninsured receive 20 percent less overall treatment for their condition and are 37 percent more likely to die of their injuries than those with insurance.

Recent studies updating the 2002 Institute of Medicine report suggest that the annual number of excess premature deaths due to uninsurance is now 22,000 deaths per year, resulting in a total of 137,000 premature unnecessary deaths from 2002-2006.

Boomers will increase premature excess deaths
Aging baby boomers will increase the premature excess deaths greatly in the future and will result in 30,000 excess and unnecessary deaths in the near elderly each year by 2015. Therefore if the mere lack of insurance (uninsurance) were categorized as a disease it would be the third leading cause of death in the near elderly behind heart disease and cancer.

No doubt, health insurance saves lives. The governor and Legislators need to directly address whose interests are served by increasing Minnesota's uninsured by 36,000 individual lives. It is time to realize that uninsurance is fatal. Sustaining this newly defined disease in the name of fiscal responsibility, tax-increase avoidance, or a balanced budget is unconscionable and unethical — and certainly poor public policy.

Michael Belzer, M.D., is medical director/chief medical officer of  Hennepin County Medical Center and associate dean of the University of Minnesota Medical School.