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More Than 46 Million Americans Lack Health Insurance

Armen Hareyan's picture

Health Insurance and Poverty Reduction

Even though the number of Americans living in poverty leveled off last year, the number of those without health insurance rose to more than 46 million in 2005, the U.S. Census Bureau said Tuesday.

Because of population growth, both the number of people without health insurance and the number of those with coverage grew between 2004 and 2005.

The number of Americans without health insurance for those full 12 months rose by 1.3 million to 46.6 million, according to the survey of 100,000 households. The percentage of people without it increased to 15.9% last year from 15.6% in 2004.

At the same time, the number who had coverage for the entire year increased by 1.4 million to 247.3 million in 2005. But the rise wasn't enough to keep the percentage with insurance from falling to 84.1% from 84.4% during that period. The nation's population expanded to 293.8 million last year from 291.2 million in 2004, according to Census estimates.

Of particular concern is the continued erosion of employer-sponsored insurance and an uptick in the number of uninsured children, some health-care analysts said. The portion of Americans covered by job-based coverage slipped to 59.5% from 59.8% in 2004. Employer-based insurance makes up the largest share, covering 174.8 million people.

Strained government programs such as Medicaid and the State Children's Health Insurance Program (S-CHIP) and fewer job-based benefits that include family dependents contributed to a rise in the number of uninsured children, said Kathleen Stoll, health policy director for Families USA, a health-care advocacy group in Washington.

"The problem is employer-based programs are becoming harder to come by and the public programs aren't filling in those gaps," Stoll said.

Financing for Medicaid and S-CHIP has grown more difficult, and eligibility standards and paperwork burdens on enrollees vary from state to state, she said.

"As states struggle with their budgets, they're implementing policies that make it harder for kids to get and stay enrolled," Stoll said. "That's a big concern."

The portion of people with public health insurance held steady at 27.3%, though the number in government programs increased to 80.2 million last year from 79.4 million, according to the survey. There was no statistical difference in the number or percentage of people covered by Medicaid - 38.1 million or 13% - between 2004 and 2005.

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Separately, the number of uninsured children increased to 8.3 million from 7.9 million, or to 11.2% from 10.8%.

Health Insurance Tracking trends

"It's clear to me that this growing number of uninsured Americans is bankrupting America, both in the pocketbook and in health," said Dr. Georges Benjamin, executive director of the American Public Health Association, a nonprofit advocacy group in Washington.

People who don't have coverage, can't afford preventive care and don't see a doctor until a disease has progressed often suffer needlessly, drive up the cost of care and lower the nation's productivity, he said.

"If you consider health to be a currency, people are not getting enough of it," Benjamin said. "We're letting people get sick because we're not taking care of them when we can do something for them, and do something for them in an economical manner."

The number of uninsured has risen every year but one since 2001, according to Census data.

Beginning in 1987 when the uninsured rate was 12.9%, the rate had a 12-year run of either increasing or not registering a statistically significant change. It peaked at 16.3% in 1998 before falling for two years in a row to 14.2% in 2000, when the job market was booming. The uninsured rate then rose until 2003-2004, where it remained at 15.6% before rising to 15.9% last year.

Generally, the uninsured were more likely to be non-white and immigrants. About 72% of the uninsured age 18 to 64 worked either full or part time, according to the survey.

There were geographic differences as well. The Midwest and Northeast had the lowest uninsured rates in 2005, at 11.9% and 12.3% respectively. The rate for those in the South was 18.6% last year and it was 18.1% in the West. Using a three-year average, the survey found that Texas had the highest percentage of uninsured at 24.6%, while Minnesota had the lowest at 8.7%.

The problem of finding and keeping health coverage isn't just an issue for the 46.6 million uninsured but for everyone who has health insurance and watches the costs of uncompensated care get passed onto them, Stoll said.

"When people are uninsured they do still get sick and go to the hospital," she said. "The cost of that care for the uninsured is shifted by the hospital to what they charge insurance companies and the insurance companies shift it to us."

The uninsured rate and more middle and lower-income workers' growing inability to afford coverage are themes likely to resonate with voters, Benjamin said. "Maybe it won't happen by November of this year but it very well could happen...by the presidential election."