Hypertension, Diabetes, And Elevated Cholesterol Among Insured And Uninsured U.S. Adults

by Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein
Health Affairs
October 20, 2009

In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often had uncontrolled conditions. Undiagnosed and uncontrolled chronic illness, which is common among insured people, is even more frequent among the uninsured.

Unrecognized or undertreated disease places uninsured people at risk for costly, disabling, or even lethal complications. For instance, many cases of kidney failure, blindness, and amputation are preventable through good diabetes control. Hypertension control is the major strategy used to combat stroke.

For the uninsured, recognition of these three conditions lags behind that of people with health insurance. Insuring the uninsured may improve care and reduce rates of disabling complications and death for Americans with these chronic illnesses.


This study confirms that being insured not only improves the control of chronic diseases, it also improves the diagnosis in individuals who are not even aware of their disorders. Insuring the uninsured can delay or even totally prevent the disastrous complications of these chronic disorders.

Current legislative proposals would leave perhaps tens of millions of individuals without insurance coverage. We cannot afford to complete the reform process until we establish policies that would cover absolutely everyone.

Our representatives in Congress need to halt the process now while they take another look at a single payer national health program – an improved Medicare for all – which actually would cover everyone. The House will have a chance to do so in the next few weeks when Rep. Anthony Weiner introduces his amendment on the House floor that would replace the language of the reform bill with the language of the single payer model.

Those who have not done so already may be interested in watching the seven minute video of Rep. Weiner’s statement when he previously introduced the single payer amendment in committee: