America's Health Care Crisis:
Cities on the Front Lines

A Report from Families USA, June 2008

INTRODUCTION

As the number of Americans without health insurance continues to grow, and, year after year, the cost of health care rises faster than workers’ wages, elected officials are taking a renewed interest in changing the nation’s health care system. However, discussions of health reform typically focus on the roles that state and federal governments play in financing coverage, frequently leaving out the stakeholders on the very front lines of the issue—cities and their leaders.

This spring, Families USA surveyed a sample of mayors1 from around the country on the topics of health care and the uninsured. The survey results show that, although each city’s involvement in health care issues is different, cities organize, fund, and deliver a wide range of health care services for their citizens through public hospitals, clinics, and a variety of other health safety net programs. Furthermore, we found that cities are profoundly affected by the rising number of uninsured Americans and the rising cost of providing coverage for their own employees. These problems have an impact on all city residents, regardless of their health insurance status, and they affect cities’ ability to fulfill other municipal functions as well.

Although city leaders have used innovative methods to try to fill in the gaps in health coverage and access, they cannot solve the deeper problems that are inherent in America’s health care system on their own. This report examines cities’ role in the health care safety net, the impact of the growing number of uninsured people on city services, and the ways that state and federal leaders might come together with city leaders to improve health coverage and access for all Americans.

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