Uninsured in U.S. Show the Biggest Increase in a Decade

WASHINGTON —  The share of Americans without health insurance increased last year by the largest amount in a decade, bringing the total number without coverage to 43.6 million, the U.S. Census Bureau reported today.

For the second straight year, rising unemployment and surging health-care costs caused a substantial decline in the number of people with employer-sponsored insurance. That pushed the total number of uninsured Americans up by 2.4 million in 2002 alone, a jump to 15.2% from 14.6%.

Growing enrollment in government-sponsored health plans -- Medicaid and the State Children’s Health Insurance Program -- kept the ranks of the uninsured from swelling even further, the Census Bureau said.

Coming on the heels of last week’s census figures showing a substantial increase in poverty and a decline in the median income, today’s report illustrates how the nation’s troubled economy has affected middle-income Americans.

As health coverage becomes unaffordable for growing numbers of people, “this is becoming an issue of self-interest for working families and the middle class,” said Ron Pollack, executive director of the consumer- advocacy group Families USA.

The increase in uninsured Americans could turn up pressure on the Bush administration, Congress and the Democratic presidential candidates to address the issue.

Most analysts see an even darker cloud looming behind today’s figures: Unemployment, health-care costs and employees’ share of insurance premiums all have gone up since last year, while states have been cutting Medicaid eligibility and benefits.

“Of the number of people who work full time, 897,000 more were uninsured” last year, Kate Sullivan, director of health policy for the U.S. Chamber of Commerce, said Monday. “I know what’s happened to health insurance costs since then.... I really am worried about what this [situation is] going to look like next year.”

The report comes as California Gov. Gray Davis faces an Oct. 12 deadline to decide whether to sign into law a bill that would require all businesses employing at least 20 people to offer health coverage by 2007.

The share of California residents without health insurance declined slightly to an average of 18.8% for the years 2001 and 2002, compared with a national average of 14.9%.

Analysts called this higher percentage a consequence of California’s large immigrant population and a poverty rate slightly above the national average.

Many officials responded Monday to the report with defenses of their own prescriptions for expanding coverage.

“Reducing the number of uninsured in America is a complex problem that requires a comprehensive solution,” Health and Human Services Secretary Tommy G. Thompson said in a statement. “President Bush has an ambitious plan that we need Congress to support.”

Among the elements listed by Thompson were increased funding for community health centers and additional incentives to doctors and other health-care providers to work in underserved areas.

Others noted, however, that Bush’s proposal to convert Medicaid from a program that automatically expands during hard economic times to one with fixed federal funding levels probably would have erased the 2002 gains in Americans covered by public insurance.

The number of people enrolled in Medicaid and its young cousin, the SCHIP program for children whose families are not quite poor enough to qualify for Medicaid, increased by about 4 million last year, said Leighton Ku, a senior fellow at the left-leaning Center on Budget and Policy Priorities.

Those expansions completely offset the decline in the number of children in families with private coverage. They resulted in a tiny decrease, to 11.6%, in the share of children who were uninsured.

As in previous years, people without health insurance were most likely to be poor, foreign-born, uneducated, young adult males who worked part time or not at all in the South or the West.

African Americans and people of Asian descent were roughly twice as likely as non-Latino whites to have no health coverage, while Latinos were three times more likely.

While the number of uninsured people with household incomes of less than $25,000 increased slightly, analysts said that was because of the greater number of poor households.

The story was different for people with household incomes between $25,000 and $49,999. Their overall number declined by about 300,000, but the number of uninsured people in that income category increased by 1.1 million, or 1.5%.

Texas, with almost 25% of its population uninsured, had the highest rate in the nation.

Most disturbing to many analysts, the share of non-elderly adults with private health insurance -- coverage sponsored by an employer or bought independently -- dropped from 73.7% to 72.2%. Only a small fraction of adults gained Medicaid coverage.

As a result, the number of uninsured adults jumped by more than 2.3 million.

As large companies have laid off employees, many of those workers have moved to smaller firms that are less likely to offer health coverage, or they have remained unemployed and uninsured.

In addition, a growing number of workers have been unable to afford their share of health insurance costs, said John Holahan, director of the Urban Institute’s Health Policy Center.

“There has been about a 15% increase in the number of uninsured adults over the last two years,” he said.

In addition to the weak economy, most analysts cited rising health-care costs -- they soared at double-digit rates in 2002 for the third straight year -- as a primary reason for the continuing decline in employer-sponsored insurance.

The average cost of an employer-sponsored family health insurance plan increased $1,100 last year to $9,068, said the chamber’s Sullivan. In 2001, employees paid an average of $30 a month for an individual policy and $149 monthly for family coverage.

By last year, those totals had increased to $42 and $200, she added.

“Affordability remains the No. 1 reason people lack health coverage today,” said Dr. Donald Young, president of the Health Insurance Assn. of America. He called on Congress and state legislatures to provide tax incentives that would make health coverage more affordable to small businesses and individuals.