After Decline, the Number of Uninsured Rose in 2001
Sept. 29 — The number of Americans without health insurance rose to
41.2 million last year, an increase of 1.4 million, and small
businesses accounted for much of the erosion in coverage, the Census
Bureau said today.
The proportion of the population without insurance also
increased, to 14.6 percent in 2001, from 14.2 percent in 2000, the
Lawmakers and lobbyists said the increase could propel health
insurance back to the forefront of national political debate. But
even as the need grows, the federal government and the states are
less able to provide aid because their revenues have shrunk in the
The proportion of Americans without insurance declined in 1999
and 2000, after rising relentlessly for a decade, even when the
economy was booming.
Economists and health policy experts suggested several reasons
for the latest increase in the uninsured: many people lost jobs last
year, and employers are the primary source of health insurance for
most Americans; rising health costs pushed up premiums, making
insurance less affordable; employers passed on more of the costs to
Households at every income level were more likely to be uninsured
last year, the Census Bureau said. The change was particularly
noticeable among people with moderate and high incomes.
The number of uninsured people with household incomes of $75,000
or more jumped to 6.6 million last year, an increase of 811,000 or
14 percent, from 2000.
Government health insurance programs covered more people last
year, the bureau said. Medicaid, the federal-state program for the
poor, covered 31.6 million people, up from 29.5 million in 2000, the
Coverage appeared to deteriorate for adults, but not for
children. The number of uninsured children, which declined in 1999
and 2000, was virtually unchanged last year, at 8.5 million. But the
number of uninsured adults rose to 32.7 million, from 31.2 million
The Census Bureau said that 11.7 percent of all children, 21.3
percent of poor children and 30.7 percent of all poor people were
uninsured for the entire year in 2001.
Robert J. Mills, a statistician at the Census Bureau, said: "The
percentage of people covered by employment-based health insurance
dropped a point, to 62.6 percent in 2001. That was the principal
cause of the overall decrease in health insurance coverage."
Small businesses are much less likely than larger companies to
offer health insurance. At companies with fewer than 25 employees,
the proportion of workers with health insurance declined last year,
to 31.3 percent, but the Census Bureau detected no change at larger
companies, where 66 percent of workers have coverage.
Still, employers of all sizes are passing on more of their health
costs to workers and retirees.
Kate Sullivan, director of health policy at the United States
Chamber of Commerce, said that many employers, while continuing to
subsidize insurance for workers, had reduced subsidies for
"A lot of insurers are dropping out of the small-group market,
and customers are balking at what they have to pay," Ms. Sullivan
said. "A small employer with seven employees can easily spend $6,000
a month, nearly $1,000 per employee, for family coverage. Premiums
are rising 20 percent a year."
Leslie M. Lauth, the owner of a microfilm and imaging company in
Durango, Colo., said cost was "absolutely the major reason" she no
longer provided health insurance for her four employees. Instead,
Ms. Lauth said, she offers each worker $75 a month for insurance.
But since the employee would also have to pay $75 to $100 a month,
she said, the workers generally forgo coverage.
The number of children without insurance leveled off last year,
after declining by 1 million in 1999 and by 700,000 in 2000.
"Progress stalled," said Genevieve M. Kenney, an economist at the
Urban Institute here. "Kids seem to be holding their own, but they
are not making further progress."
In 2001, the Census Bureau said, some children lost health
insurance that they had been receiving from their parents'
employers, but this decline was offset by an increase in coverage
under Medicaid or the Children's Health Insurance Program.
The number of children with employer-sponsored health insurance
dropped by 1 million last year, to 46.4 million from 47.4 million in
2000. At the same time, the number of children with government
health insurance rose by nearly 1.2 million, to 18.8 million.
Many more children could be enrolled. "Half to three-fourths of
all uninsured kids are eligible for Medicaid or the Children's
Health Insurance Program," Ms. Kenney said. "In many cases, parents
don't know their children could qualify."
States have not used all the money available to them under the
Children's Health Insurance Program. When the new fiscal year begins
on Tuesday, $1.2 billion of federal money will revert to the
Treasury and can be used for other purposes unless Congress
preserves it for child health care.
"It would be a huge mistake to let this money disappear," said
Thomas A. Scully, administrator of the federal Centers for Medicare
and Medicaid Services.