1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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For some time now, I've intended to write an editorial on the national disgrace of uninsured Americans. I do so now for two reasons.


First is my growing sense of urgency. After declining for two years, the number of uninsured Americans increased by 1.4 million in 2001, for a total of 41.2 million. That's one in every seven people. These numbers will likely increase, given that unemployment rates are rising and health insurance is often tied to jobs. Larry Levitt of the Henry J. Kaiser Family Foundation estimates that 85 of every 100 people who lose their jobs also lose their insurance.


Second, I haven't written on this topic before now because I felt somewhat hopeless: this country hasn't shown enough caring to make health care the right of every citizen. But now a remarkable coalition has been formed to rouse us from our collective stupor. Called "Covering the Uninsured," the coalition has designated the week of March 10 to 16 as Cover the Uninsured Week. The time has come for action.


If you need convincing, consider these statistics: the Henry J. Kaiser Family Foundation reported in February 2002 that 80% of uninsured Americans are children and working adults. Rising premiums, copayments, and deductibles prohibit some families from participating in health insurance programs offered by employers. In the September-October issue of Health Affairs, Jon Gabel and colleagues reported a 12.7% increase in insurance premiums between spring 2001 and spring 2002-that's quadruple the rate of inflation.


Also, this trend affects nurses. Whatever safety nets have existed for the uninsured are unravelling. For example, Los Angeles County closed 11 of its 18 health clinics last year, leaving many of the city's poorest residents to go to EDs for routine care. If you work in an ED or a public hospital with too few nurses, you've seen the ambulance diversions from other overcrowded EDs. Perhaps you've also seen patients who postponed routine care and suffered severe consequences-like the woman who couldn't afford antihypertensive therapy and is now on an ICU respirator after a stroke, receiving care that's costly to taxpayers. And imagine the impact of someone exposed to an agent of bioterrorism such as anthrax or smallpox who doesn't seek care because of a lack of health insurance. The public health consequences are incalculable.


Many nurses know they cannot care for uninsured patients as they deserve and ethics demands. In its 2002 report Care Without Coverage: Too Little, Too Late (, the Institute of Medicine concluded that the uninsured receive lower quality care and less of it, noting, for example, that uninsured women with breast cancer are diagnosed at a later stage and have a 30% to 50% greater chance of dying than women who are insured.


And one day, you and I could join the ranks of the uninsured. Nurses House, the only charity for nurses in need, receives requests for assistance from nurses who have little or no health insurance. But there's plenty nurses can do. Covering the Uninsured includes such disparate groups as the U.S. Chamber of Commerce, the ANA, the the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), the Health Insurance Association of America, the Business Roundtable, the American Medical Association, and the Robert Wood Johnson Foundation, among others. Between March 10 and 16 (and after), write letters to the editor, speak on radio and television, and discuss the issue with the community groups to which you belong. What better spokespeople for this campaign than nurses, daily witnesses to our nation's failure to insure all its citizens?


We live in the only industrialized nation that does not ensure universal coverage of all of its people, and we should be ashamed of that fact. For examples of how to act, go to and