Universal health care is not the norm in the United States today. More than 40 million consumers lack access to health insurance. These uncovered customers include not only low-income consumers but workers for small business as well.

Largely as a result of their lack of access to health insurance, low-income consumers have markedly poorer health outcomes. Low-income consumers are more subject to acute and chronic disease, as well as to traumatic injury. Low-income consumers have higher death rates and poorer birth outcomes (e.g., low weight babies, infant mortality).

Because of this disparity in health care outcomes, substantial work is being undertaken to promote universal health care service. FSC has engaged issues surrounding the design and promotion of universal service in the health care industry and the consideration of the community service obligations health care providers bear.

In particular, the merger of health care institutions is usually undertaken in the name of cost-cutting "efficiencies." Care must be taken that cost-cutting does not threaten either the quality or diversity of services offered to the full range of customers.