HEALTH INSURANCE: 16% Now Lack Coverage
Despite a "booming" economy, low unemployment and recent government efforts, a Census Bureau report released Friday shows that 43.4 million Americans -- roughly 16% of the population -- have no health insurance, a steep 1.7 million increase since 1996. Experts cited several reasons for the increase: new welfare-to-work laws push people from Medicaid into low-paying jobs without health benefits; rising medical costs have forced some employers to reduce health benefits, particularly for employees' dependents; and small businesses, which often do not provide health insurance, are generating most of the nation's new jobs.
- Half of the increase in the number of uninsured comes from households with annual incomes above $75,000. About 8.1% of them are uninsured, up from 7.6 percent in 1996, most likely because they are "self employed or worked for small businesses that did not provide coverage."
- The proportion of poor people without health insurance remained unchanged at about 31.6%.
- People age 18 to 24 are most likely to be uninsured, with 30% lacking coverage, up from 28.9% two years ago.
- Thirty-four percent of Hispanics were uninsured, compared to 21.5% of blacks and 12% of whites.
- In six states, more than 20% of people are uninsured -- Texas, Arizona, Arkansas, New Mexico, California and Mississippi (Pear, New York Times, 9/26).
- Roughly one half of the full-time working poor were uninsured last year, and part-time workers, the less educated, and the foreign born were among those least likely to have coverage.
- Five states saw an increase in coverage -- Louisiana, Missouri, New Mexico, Rhode Island and Vermont. But 16 states saw a decrease -- Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Idaho, Michigan, Nebraska, New Jersey, New York, North Dakota, South Carolina, South Dakota, Utah and West Virginia (Reuters/Washington Post, 9/27).
- Medicaid enrollment decreased by 1.8 million, "apparently as a result of welfare cutbacks."
- "[D]espite rising employment, the proportion of Americans with private coverage actually fell slightly from 70.2% to 70.0%" (Physicians for a National Health Program release, 9/25).
Dr. Steffie Woolhandler, coauthor of the report, which was published by Physicians for a National Health Program, said, "We're just treading water now, but if we see a downturn in the economy, we're going to start sinking." The Boston Globe reported that the nation is "treading water" despite state efforts to "expand Medicaid eligibility," the $24 billion federal Children's Health Insurance Program, and the "1996 federal 'portability' law." Woolhandler said, "These programs are not making a dent in the problem of the uninsured. We had the equivalent of 125,000 people lose health insurance every month this past year" (Pham, 9/26) And as for state and federal programs, Diane Rowland of the Kaiser Commission on Medicaid and the Uninsured said that "changes in welfare and immigration law had deterred some people from applying for Medicaid" (New York Times, 9/26). Harvard's Dr. David Himmelstein concluded, "These may be the best of times for the economy, but they are the worst of times for health care. Uninsurance is rising, even people with coverage often can't get the care they need, and costs will double in the next decade. It's time to reopen debate over national health insurance" (Physicians for a National Health Program release, 9/25).
Rising Costs Across the States
Next year, HMO premiums may rise 5% to 7%, 7% to 11% in "looser managed care plans," and as much as 15% in indemnity plans, according to Watson Wyatt Worldwide, a benefits consulting firm. These projections are in line with recent Health Care Financing Administration findings, which predict a 7.9% overall premium increase. The Bureau of Labor Statistics found that medical costs, as measured by the Consumer Price Index, rose 3.5% in the last twelve months, up from 2.6% the year before. Insurance industry officials cite "'bracket creep' as the work force ages" and "catch up" from recent losses and narrow profit margins as factors driving the increase (Salganik, Baltimore Sun, 9/27). State insurance reforms may also be increasing both costs and the number of uninsured, according to a recent study by the Galen Institute. Forty five states have adopted some level of insurance reform in the 1990s, including laws "requir[ing] insurers to cover anyone who applied, barr[ing] insurers from using someone's health status to set rates, and restrict[ing] the exclusion of pre-existing conditions." The Galen study found that "[t]he 16 states with the toughest rules" saw a 25.6% increase in the number of people without insurance (Litvan, Investor's Business Daily, 9/28). California "experienced the largest jump," with 575,000 more people uninsured. Michigan followed close behind with 276,000 more uninsured people, Illinois with 169,000, and roughly 100,000 more uninsured in Florida, Alabama and Maryland (release, 9/25). The survey's results are available on the Internet at www.census.gov/hhes/www/hlthins.html.