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Rising Insurance Rates - A Growing Problem

More than 80 million Americans lacked health insurance for all or part of 2002 and 2003, almost double the number of Americans who were without health insurance for the entire year of 2002, according to a new report from Families USA.

Based on current figures from the U.S. Census Bureau, the health care consumer advocacy organization found that 81.8 million Americans - or one out of three people younger than 65 - had no health insurance for a period of time during 2002 and 2003. Of the 81.8 million individuals, more than 65 percent were uninsured for six months or more. While U.S. Census figures released last year found that 43.6 million people were uninsured in 2002, those figures counted only how many people did not have health insurance for the entire year. Although many individuals included in the Families USA report, "One in Three: Non-Elderly Americans Without Health Insurance, 2002­2003," may have been uninsured for only portions of a year, the effects on their health can be just as detrimental as those uninsured for an entire year.

"This issue is no longer just an altruistic issue affecting the poor," said Ron Pollack, executive director of Families USA, at a Washington, D.C., news conference releasing the report in mid-June.

The Families USA report broke the numbers down even further by state, with more than one out of three of the total population of Texas younger than 65 uninsured for some or all of 2002­2003 - the highest rate in the country. Following Texas were New Mexico, California, Nevada, Louisiana, Arizona, Mississippi, Oklahoma, Alaska, Florida, Arkansas, North Carolina and New York.

Also, more than four out of five people who were uninsured in the time period studied by Families USA were connected to the work force as of December 2003, either through employment or looking for employment. And although low income level increases an individual's likelihood of not having health insurance, Families USA found that about 25 percent of working individuals and their families with an annual income of $55,908 to $74,640 also were uninsured. Sadly, 27 million of those without health coverage during all or part of 2002­2003 were children.

Uninsurance numbers also varied by race and ethnicity. Speaking at the Washington, D.C., news conference, U.S. Rep. Hilda Solis, D-Calif., noted that although the majority of Hispanics living in the United States work, many don't get health coverage. Such a lack of insurance only contributes to widening health disparities, especially as many Hispanic communities are located in the poorest areas with the worst environmental health conditions, Solis said. In fact, almost 60 percent of Hispanics and about 43 percent of blacks were uninsured in 2002­2003, compared to about 24 percent of whites, Families USA reported.

Rising uninsurance numbers, as well as rising health care costs, are a major concern for state governments struggling with budget shortfalls, according to Iowa Gov. Tom Vilsack, who spoke at the Families USA news conference. Vilsack called on the federal government to continue supplemental funding for state Medicaid programs and spoke of the need to expand the Children's Health Insurance Program. In 2003, Congress passed legislation that temporarily increased federal contributions to state Medicaid programs even though tight state budgets resulted in some cuts being made anyway. The temporary federal increase in Medicaid funding expired in June and, as of press time, had not been renewed.

If fiscal relief stops flowing to Medicaid, it will be more difficult to ensure long-term care under the program, and expanded access for children could be reigned in, Vilsack said. He noted that when states receive less federal money, they can't adequately reimburse health providers, which in turn reduces the number of physicians willing to treat low-income people and puts a heavier burden on hospitals.

In Kansas, officials may also have to curtail services to the state's poorest, according to Kansas Gov. Kathleen Sebelius, who also spoke at the June news conference. Sebelius said President Bush and his administration are turning a "deaf ear" to state problems.

"We need a partner in Washington who understands what states can and cannot do," she said.

Medicaid is not necessarily the health care safety net that many assume it is, according to Families USA. Medicaid eligibility rules differ from state to state and oftentimes do not help low-wage workers and their families living without health insurance. Also, in more than 40 states, an adult who is not a parent "can literally be penniless and not qualify for Medicaid or any other public coverage," the report stated.

"(Uninsurance) is the most important issue we could be talking about," Sebelius said.

Another study released in June found that even families with health coverage had trouble paying their medical bills. In 2003, almost 20 million American families were forced to make difficult choices between medical, food and housing expenses, according to the study, which was released by the Center for Studying Health System Change. Millions of people among the almost 20 million families with medical debt problems also had difficulty receiving medical care. For example, one in three did not get a needed prescription drug, one in four delayed medical care and one in eight simply went without care, the study reported. Of course, uninsured families had the hardest time paying medical bills.

Americans living without health coverage were at the forefront of national discussion during Cover the Uninsured Week 2004, which ran from May 10­16. During the week, the Robert Wood Johnson Foundation released the report "Characteristics of the Uninsured: A View from the States," which showed that the problem of uninsurance is pervasive in every state. Cover the Uninsured Week 2004 included more than 2,600 events and more than 2,000 participating local groups, resulting in more than 1,000 print news articles. As a supporter of the event, APHA and its state and local Affiliates took part in a number of events highlighting uninsurance.

Also, in June, Service Employees International Union, Jobs with Justice and Rock the Vote launched Bridging the Gap for Health Care.

On June 19, tens of thousands of Americans came together in all 50 states to march across the nation's bridges to bring attention to the uninsured and call for affordable health care.

For more information on national uninsurance events, visit http://www.covertheuninsuredweek.org/ or http://www.bridgingthegapforhealthcare.org/. For a copy of the Families USA report, visit http://www.familiesusa.org/.

Kim Krisberg
Reprinted with permission from The Nation's Health, APHA

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