Reading    People Lacking Health Insurance

Big Increase Seen in People Lacking Health Insurance

September 30, 2003



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

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

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."