Census Finds
Many More Lack Health Insurance 

CECI CONNOLLY / Washington Post 30sep03

The number of Americans who lack health insurance climbed by 5.7 percent in 2002, to 43.6 million, the largest single increase in a decade, according to figures to be released today by the Census Bureau. [Full report at Census Bureau website 256kb PDF file]

Overall, 15.2 percent of Americans were uninsured last year, up from 14.6 percent in 2001. The largest jump came among people who had received health benefits through their jobs, as some firms laid off workers and others reduced coverage. Young adults and Latinos once again were the least likely to have medical coverage. Primarily because of government-run health programs, children and the elderly have the highest rates of coverage.

Coupled with a report last week showing a similar rise in poverty, the health insurance data help illuminate the human toll of the nation's stalled economy.

Lacking Coverage

The number of people without health insurance
reached 43.6 million last year, an increase 
of 2.4 million.

15.2 % of the population was without health 
insurance for all of 2002

Age 		  Percentage
Under 18 	  12%
18-24 		  30%
25-34 		  25%
35-44 		  18%
45-64 		  14%
65+ 		  1%

Household Income
Under $25,000 	  24%
$25,000-49,999 	  19%
$50,000-74,999 	  12%
$75,000+ 	  8%

Employment
Worked Full-Time  17%
Worked Part-Time  24%
Did Not Work 	  26%

Source: US Census Bureau & Washington Post

Since President Bush took office, the United States has lost 2.7 million jobs and household incomes have fallen for three years in a row. Administration officials suggest those trends have begun to turn around, but Democrats have seized on economic issues in their quest to defeat Bush in next year's presidential election.

Advocates of comprehensive health coverage said leaders in both political parties need to focus more energy on the uninsured, whose numbers rose for the second year in a row, and rising medical costs.

"These figures and those on the poverty level in the United States indicate our country has a profound challenge in front of it, namely how, with all the wealth and power we have aggregated, can we ensure that all Americans are at the table of economic opportunity and have access to health care," said the Rev. Michael Place, president of the Catholic Health Association of the United States. "What we need from leaders is the same type of focus that can win a war in Iraq (news - web sites)."

"The president is committed to getting the economy growing faster so the number of unemployed and uninsured Americans will go down," said White House spokeswoman Claire Buchan.

Health policy experts expected the number of uninsured Americans to grow, but many expressed surprise at the breadth and depth of the increase. Not since 1992 has the nation experienced such a steep drop in health coverage, an issue Democrat Bill Clinton capitalized on in his successful campaign against President George H.W. Bush.

"These numbers are a real wake-up call to the fact lack of insurance is a growing problem in the United States," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, a bipartisan health policy institute.

The most startling story line behind the census figures is the ongoing loss of health benefits in the workplace. For the second year in a row, the proportion of people who received insurance through an employer fell, from 62.6 percent in 2001 to 61.3 percent last year. Cost appeared to be the primary reason for the decline.

"Employment-based coverage is getting really expensive," said Kate Sullivan, director of health care policy at the U.S. Chamber of Commerce (news - web sites). "Either the company doesn't make it available or individuals are turning down coverage at work because they can't afford it. That's very alarming."

The average cost of a family health plan rose from $8,000 in 2002 to more than $9,000 this year and is expected to exceed $10,000 in 2004, said Helen Darling, president of the Washington Business Group on Health, which represents 180 major corporations.

"When you think about the average wage in this country being only $27,000, somebody's going to say, 'Wait a minute, I can't afford an employee at that level,' " she said.

It wasn't just low-wage workers who struggled to afford health coverage, said Sullivan, noting that 900,000 full-time workers lost insurance in 2002. "The number of people earning over $50,000 without coverage is rising," she added. "This shows they're not immune."

The situation could have been far more dire. Were it not for the growing numbers of people who either purchased their own insurance or enrolled in a government-subsidized program, the total number of uninsured Americans would have been 2.9 million greater, the data show.

Health and Human Services Secretary Tommy G. Thompson said the growth in Medicaid and the Children's Health Insurance Programs (CHIP) demonstrated the administration's commitment to helping children and families obtain care. By giving states permission to experiment with those programs, Thompson said HHS has helped expand coverage to 2.4 million people. Today, nearly one in four children receives care through Medicaid or CHIP.

Still, analysts said it is hard to see how financially strapped states can sustain the costly health programs.

"All across the country states are experiencing fiscal crisis and a good number are considering cutting their Medicaid programs," said Ron Pollack, executive director of the liberal consumers group Families USA.

As always, there were wide variations among the states. Minnesota showed the greatest success, with 92 percent of its residents covered by private or government programs. Texas has the highest number of uninsured residents -- 24.7 percent over a two-year period, according to the Census Bureau.

Locally, the number of people without insurance rose slightly in Maryland and Virginia, to 12.8 percent and 12.2 percent, respectively. In the District, about 13 percent of residents continue to lack coverage.

source: http://www.washingtonpost.com/wp-dyn/articles/A19511-2003Sep29.html 30sep03

Big Increase Seen in
People Lacking Health Insurance

ROBERT PEAR / NY Times 30sep03

WASHINGTON, Sept. 29 — The number of people without health insurance shot up last year by 2.4 million, the largest increase in a decade, raising the total to 43.6 million, as health costs soared and many workers lost coverage provided by employers, the Census Bureau reported today.

The increase brought the proportion of people who were uninsured to 15.2 percent, from 14.6 percent in 2001. The figure remained lower than the recent peak of 16.3 percent in 1998.

A continued erosion of employer-sponsored coverage was the main reason for the latest increase, the bureau said. Public programs, especially Medicaid, covered more people and cushioned the loss of employer-sponsored health insurance but "not enough to offset the decline in private coverage," the report said.

The proportion of Americans with insurance from employers declined to 61.3 percent, from 62.6 percent in 2001 and 63.6 percent in 2000. The number of people with employer-sponsored coverage fell last year by 1.3 million, to 175.3 million, even as the total population grew by 3.9 million.

Tommy G. Thompson, the secretary of health and human services, said the numbers showed that "the nation must do more" to help the uninsured. Mr. Thompson said, for example, that Congress should provide tax credits for the purchase of private insurance.

But no action is imminent. Congress is preoccupied with efforts to help a large, politically potent group that already has insurance, the elderly, by adding drug benefits to Medicare.

Ronald F. Pollack, executive director of Families USA, a liberal-leaning consumer group, said: "It's hard to grasp the magnitude of the number of uninsured. It exceeds the aggregate population of 24 states."

The number of full-time workers without health insurance rose by 897,000 last year, to 19.9 million. Kate Sullivan, director of health care policy at the United States Chamber of Commerce, said the increase was alarming and predicted it would continue this year.

"Workplace coverage is becoming unaffordable for many employers and employees," Ms. Sullivan said.

On Friday, the Census Bureau reported that poverty rose in 2002 for the second consecutive year. The poverty rate generally declines when the economy expands, but there is no guarantee that the number of uninsured will also decline.

The number of uninsured increased each year from 1987 to 1998, even when the economy was booming. Small businesses accounted for many of the new jobs then, and such businesses are far less likely to provide insurance.

Health policy experts said the number of uninsured was likely to rise this year because the job market remains weak and many states have cut back their Medicaid programs. The unemployment rate was higher in 2002 than in 2001 and has climbed a bit further this year.

Hanns Kuttner, a health policy analyst at the University of Michigan, said: "Rising rates of unemployment tend to erode health insurance coverage among adults. But when parents lose jobs, their children are more likely to be eligible for public programs."

About 8.5 million children were uninsured in 2002. They account for 11.6 percent of all children under 18. Both numbers were virtually the same as in 2000 and 2001.

Genevieve M. Kenney, an economist at the Urban Institute here, said: "Programs intended to provide coverage for children are working to compensate for the economic downturn and catching a lot of kids who would otherwise be uninsured. But many states, in the midst of a fiscal crisis, have reduced efforts to locate and enroll children eligible for Medicaid."

Men are more likely to be uninsured than women. Men accounted for two-thirds of the increase in the number of uninsured, apparently because they were more likely to lose employer-sponsored coverage.

The number of uninsured men rose by 1.6 million last year, to 23.3 million, while the number of uninsured women rose by 761,000, to 20.2 million.

The drop in coverage came even though the number of people with health insurance increased, by 1.5 million last year, to 242.4 million. But the increase was more than offset by the combined effects of population growth and the decline in workplace coverage.

The proportion of people without health insurance ranged from 8 percent in Minnesota to 24.1 percent in Texas. The rates for Rhode Island, Wisconsin and Iowa, which have made sustained efforts to expand coverage, were similar to the figure in Minnesota.

Texas, facing fiscal problems and unwilling to raise taxes, cut back Medicaid and its Children's Health Insurance Program this year.

Looking at two-year averages, the Census Bureau said that the proportion of people without coverage fell in New Mexico but rose in 18 states: Colorado, Idaho, Indiana, Maryland, Michigan, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, North Carolina, Oregon, Pennsylvania, Rhode Island, Texas, Vermont, Virginia and Wisconsin. The changes in the other states were not statistically significant.

People in the South and the West were more likely to be uninsured. Only 11.7 percent of people in the Middle West were uninsured, compared with 13 percent in the Northeast, 17.1 percent in the West and 17.5 percent in the South.

As an entitlement program, Medicaid expands to meet the need in hard economic times.

Despite the Medicaid program, 10.5 million poor people, or 30.4 percent of those in poverty, had no health insurance last year. This percentage, double the rate for the total population, did not change from the prior year. About 24 percent of all uninsured people were poor.

The proportion of blacks and non-Hispanic whites without health insurance rose last year, to 20.2 percent and 10.7 percent, respectively. The figure for Hispanics was much higher, 32.4 percent, unchanged from the prior year.

Fully one-third of the foreign-born population was uninsured. About 43 percent of noncitizens — 8.9 million of the 20.6 million noncitizens — and 17.5 percent of naturalized citizens lacked coverage.

Among people living in poverty, 49 percent of those who worked full-time were uninsured.

But middle-income households accounted for most of the increase in the number of uninsured. In households with annual incomes of $25,000 to $74,999, the number of uninsured people rose last year by 1.4 million, to 21.5 million, and the increase was most noticeable among households with incomes of $25,000 to $49,999.

At companies with fewer than 25 employees, only 30.8 percent of the workers had employer-sponsored insurance in their own names last year, down from 31.3 percent in 2001. The proportion of workers with insurance also declined at companies with 25 to 99 employees (by 2.4 percentage points, to 54.4 percent) and even at businesses with more than 1,000 employees (by nine-tenths of a percentage point, to 68.7 percent).

Senator Max Baucus, Democrat of Montana, said he was working with Senator Charles E. Grassley, Republican of Iowa, on a bill that would offer tax credits to jobless workers to buy certain types of health insurance.

"We have long known the problem of the uninsured is serious," Mr. Baucus said. "This week's data show that it's getting worse."

source: http://www.nytimes.com/2003/09/30/politics/30INSU.html?pagewanted=print&position= 30sep03

43.6 million don't have health insurance

JULIA APPLEBY / USA Today 30sep03

The number of U.S. residents without health insurance rose at the fastest clip in a decade last year, hitting 43.6 million, a development expected to increase pressure on lawmakers to take strong action to ease the problem.

About 15% of the population was without insurance in 2002, Census Bureau (news - web sites) figures released Tuesday show. The number of uninsured grew by 2.4 million, the largest increase since 1991-92, when 3.2 million lost coverage.

Many of those people lost their jobs and their insurance because of the struggling economy. For some, insurance was lost when double-digit premium increases caused employers to stop offering coverage. Some of the uninsured opted not to enroll in coverage offered by employers, as the amount taken from their paychecks to cover the cost rose.

Slowing the increase in the uninsured last year was a rise in the number of residents enrolled in Medicaid, the federal/state health program for the poor. The number of uninsured children fell, reflecting an effort to enroll eligible low-income children in government health plans. Overall, the number of residents with insurance rose by 1.5 million, mainly due to population growth.

This year, many state Medicaid programs are facing cuts and adult enrollees are being dropped from coverage.

"If what we are experiencing in our emergency rooms and clinics across the county is any indication ... my fear is the 2003 figures will be far worse," Michael Place, president and CEO of the Catholic Health Association of the United States, an association of Catholic hospitals, clinics and health plans. Member hospitals report a steady increase in patients without insurance or without adequate coverage.

The rapid rise in the number of uninsured means lawmakers will feel pressure from constituents who are worried about losing coverage, says Paul Ginsburg, president of the Center for Studying Health System Change, a non-partisan research group in Washington.

He expects lawmakers will consider more far-reaching proposals than those seen in recent years: "Incremental change is dead for now."

The Bush administration has called for increased funding for health clinics and a tax credit for low- and moderate-income residents to help offset the cost of buying health insurance. Presidential candidates have suggested a range of plans, many of which would expand existing government health programs.

The largest increase in the uninsured a jump of 1.1 million came in households earning $25,000 to $49,999 a year. The next-largest jump, 633,000, came in households with incomes of $75,000 or more. The smallest jump was among households with less than $25,000 in income, the group most likely eligible for government aid. Still, the lowest-income group represents the largest total number of uninsured.

More in U.S. Without Health Insurance

LISA RICHWINE / Reuters 30sep03

WASHINGTON—The ranks of Americans without health insurance grew by an estimated 2.4 million in 2002, the second consecutive yearly increase, the U.S. Census Bureau (news - web sites) reported on Tuesday.

About 15.2 percent of the population, or 43.6 million people, lacked medical coverage for the entire year, the Census Bureau said in a report that prompted new calls for lawmakers and President Bush (news - web sites) to address the problem. In 2001, 14.6 percent lacked health coverage.

Last year's drop was attributed largely to fewer people receiving insurance from employers. The percentage of those covered by employment-based health insurance slid to 61.3 percent in 2002 from 62.6 percent in 2001, the report said.

Some of the uninsured had lost their jobs as the economy struggled through a recession, according to policy experts.

In other cases, employers dropped health coverage as premiums rose, or increased employees' portion of the cost to the point that some workers could not afford to pay.

"Clearly employers are struggling to hang on to their coverage," said Kate Sullivan, director of health care policy for the U.S. Chamber of Commerce (news - web sites).

Government insurance programs such as Medicaid provided a cushion. About 25.7 percent of people were covered by the government program in 2002, up from 25.3 percent in 2001.

"Things could have been substantially worse" without the government assistance, said Leighton Ku, a senior fellow at the liberal-leaning Center on Budget and Policy Priorities.

The new figures should spur politicians to quickly agree on ways to help more people obtain medical coverage, said Ron Pollack, executive director of Families USA, a health advocacy group.

"The failure to do so may have significant repercussions in the 2004 elections," Pollack said.

Lawmakers have philosophical differences over the best way to help the uninsured. Republicans tend to favor market-oriented solutions such as tax credits. Democrats usually support a larger government role in covering the uninsured.

Health and Human Services (news - web sites) Secretary Tommy Thompson said Congress should pass the administration's plans, which include tax credits to help make private insurance more affordable, expansion of the government's tax-free Medical Savings Accounts program and more funding for state health insurance for children.

"Congress must give us more tools to provide more care to more families," Thompson said in a prepared statement.