UNINSURANCE: State Rate Climbed By 1.5 Million In Last Decade

      In what is "the first comprehensive look" at insurance trends in the 1990's, a study in this month's American Journal of Public Health found that the number of Californians without health insurance has skyrocketed by 1.5 million since 1989. "Despite a strong economy in California, more and more working families are not covered by health insurance with one in every five Californians not having any health care coverage," said Dr. John Roark, president of the California Physicians Alliance. While the study found the national rate of uninsurance (16%) to be disheartening, the outlook was even worse for California which pegged its uninsurance rate at 21.5% (CPA release, 12/30).

Not In America
      The study, publicized by Physicians for a National Health Program (PNHP), reports that the total number of uninsured is presently 43.4 million, but that the rate continues to rise by over 100,000 people every month. "By the time Congress finishes with the impeachment debate, another half-million people will have lost their health insurance," said co-author Dr. David Himmelstein of Harvard Medical School. The troubling numbers come despite the nation's strong economic growth, the authors note, pointing out that during the same period of time the Gross National Product has increased more than 25% and the Dow Jones Industrial Average has doubled. While one in seven (13.6%) Americans were uninsured at the start of the decade, that number is up to one in six (16%), with young adults, blacks and Hispanics being the most adversely affected. Even worse, though, are several southern and western states (Texas, Arkansas, New Mexico and Arizona) where one in four are uninsured (release, 12/30). "What's clear is that there is a long-term, steady and quite striking increase in the number of uninsured," Himmelstein said, noting that the number of uninsured Americans is "about what it was 35 years ago, when the Medicare and Medicaid programs were launched to cover the elderly and the poor."

The Bad News
      The Baltimore Sun reports that the study attributed the problem of uninsurance to "decreasing union membership, increasing use of part-time workers and the shift of jobs from manufacturing to service industries" (Salganik, 12/31). The Chicago Tribune reports that analysts say "people leaving state welfare rolls and therefore losing Medicaid coverage, and military downsizing, which has resulted in fewer people covered by the Civilian Health and Medical Program of the Uniformed Services," have also contributed to the bleak picture (Japsen, 12/31). And governmental reforms to insure more Americans have made little impact, according to the authors. "Incremental reforms have had no impact on the rising number of uninsured," said co-author Dr. Olveen Carrasquillo of Columbia Presbyterian Hospital. "The Kennedy-Kassebaum Insurance Portability Act has helped few people between jobs keep their insurance, and the Children's Health Insurance Plan is not stemming the rising tide of uninsurance among children," Carrasquillo added (release, 12/30).

More Bad News
      Further, the Chicago Tribune reports that the authors said it was unlikely that the "economy will 'outgrow' the problem of the uninsured." As "next year's health care insurance costs are expected to rise to a level more than five times the current overall inflation rate," many analysts "say some companies, mostly small ones, might drop coverage." Former American Public Health Association President Dr. Quentin Young said the uninsurance problem is due to businesses not wanting to pay the "huge amount" that it costs to cover employees' benefits package. "This is a mega-phenomenon and not just 13 people in Syracuse. Most of the uninsured are working people and their families," he said (12/31).

Wake Up And Smell The Coverage
      The study authors conclude that major changes are necessary. "Our health care system needs comprehensive changes rather than the piecemeal approaches that policymakers continue to advocate," the authors write, noting that the Universal Declaration of Human Rights states that everyone deserves the right to medical care. "Accordingly, we believe, as do more than 80% of Americans, that health care, like education and social security, is a right and not a privilege," they conclude (Carrasquillo et al., American Journal of Public Health, 1/99 issue). The Sun reports that study authors Himmelstein and Dr. Steffie Woolhandler are co-founders of PNHP, a group that favors what Himmelstein called a "single-payer, Canadian-style national health system" (12/31). The study was based on Census Bureau data from 1989 to 1996 (release, 12/30).