Ten years after Congress rejected President Clinton's proposed overhaul of the health care system, the report released Wednesday says only major reform at the federal level will make universal coverage a reality.
"It is time for our nation to extend coverage to everyone," says the report, the last of six studies over three years that explored aspects of the lack of health insurance.
The Census Bureau reported that 43.6 million people lacked health insurance at some point in 2002, up from 39.8 million in 2000.
In addition to covering everyone, health insurance should be continuous, affordable for individuals and families and sustainable for society, the study says.
The report does not endorse a specific proposal, noting three approaches that it said would result in insurance for nearly every American:
Strong, bipartisan political support is necessary whichever option is selected, the study says. The Institute is an arm of the National Academy of Sciences, a private organization chartered by Congress to provide scientific advice to the government.
Health and Human Services Secretary Tommy Thompson said universal coverage by 2010 is "not realistic."
In a meeting with reporters this week, Thompson said, "I just don't think it's in the cards. I don't think that administratively or that legislatively it's feasible."
The Bush administration last year proposed spending up to $89 billion in health care tax credits to help those who do not have employer-based coverage, but the Republican-led Congress took no action.
Thompson said the president would have more to say about the uninsured in next week's State of the Union address.
Among Democratic presidential candidates, Rep. Dennis Kucinich of Ohio, former Sen. Carol Moseley Braun of Illinois and Al Sharpton support a single-payer system to cover everyone. The other candidates are proposing more limited reforms, with Rep. Dick Gephardt of Missouri supporting a requirement for employers to provide health insurance coverage to workers.
In previous reports, the institute has estimated that the lack of health insurance causes 18,000 unnecessary deaths in the United States and costs the nation $65 billion to $130 billion annually.
Layoffs and cutbacks in health benefits by employers have led even those with insurance to worry that they could lose it. Lack of adequate health insurance "creates insecurity for everyone, because losing that coverage tomorrow is so easy," the report says.
The Census Bureau said a decline in workplace-based coverage was the main reason for the increase in uninsured between 2001 and 2002.
The study also says that in the interim, federal and state governments should ensure that everyone eligible for low-income health insurance be covered. States have been restricting enrollment in Medicaid and State Children's Health Insurance Programs to deal with budget deficits.