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Diabetes, Health Insurance, and Health-Care Reform

In this issue of Diabetes Care (p. 585–591), Harris, Cowie, and Eastman analyze results from the 1989 National Health Interview Survey, and they describe health insurance coverage for U.S. adults ≥18 years of age. Of all people with diabetes, 13.5% of those 18–64 years of age and 1.2% of those ≥65 years of age report having no health insurance. The former is a national tragedy. The latter clearly reflects a success of Medicare. Before Medicare's enactment in 1965, 44% of the elderly in the U.S. had no hospital insurance (1). Although the authors do not comment on people with diabetes who are <18 years of age, the 1988 National Health Interview Survey on Child Health fou d that 17% of U.S. children and adolescents were not covered by a health insurance plan (2). As has been described by others, the authors found only small differences in rates of coverage between people with and without diabetes (3). They did, however, describe important differences in types of coverage. People with diabetes who were 18–64 years of age were more likely than those without diabetes to report coverage through Medicaid and Medicare, and were less likely to report having private insurance. having some other type of health insurance.