Steep rise seen in number of uninsured

43.6 million lacking health plan; increase is highest in a decade

By Ceci Connolly, Washington Post, 9/30/2003

WASHINGTON -- The number of Americans who lack health insurance climbed by 5.7 percent in 2002, to 43.6 million, the largest single increase in a decade, according to figures to be released today by the US Census Bureau.

Overall, 15.2 percent of Americans were uninsured last year, up from 14.6 percent in 2001. The largest jump was among people who had received health benefits through their jobs, as some firms laid off workers and others reduced coverage. Young adults and Latinos once again were the least likely to have medical coverage. Children and the elderly have the highest rates of coverage, primarily because of government-run health programs.

Coupled with a report last week showing a similar rise in poverty, the health insurance data help illuminate the human toll of the nation's stalled economy, an issue that threatens to bring President Bush political headaches as he gears up to seek reelection.

Since Bush took office, the United States has lost 2.7 million jobs and household incomes have fallen for three years in a row. Administration officials suggest those trends have begun to turn around, but Democrats have seized on economic issues in their quest to defeat Bush.

Advocates of comprehensive health coverage said leaders in both political parties need to focus more energy on the uninsured, whose numbers rose for the second year in a row, and rising medical costs.

"These figures and those on the poverty level in the United States indicate our country has a profound challenge in front of it, namely how, with all the wealth and power we have aggregated, can we ensure that all Americans are at the table of economic opportunity and access to health care," said the Rev. Michael Place, president of the Catholic Health Association of the United States. "What we need from leaders is the same type of focus that can win a war in Iraq."

White House spokeswoman Claire Buchan said, "The president is committed to getting the economy growing faster so the number of unemployed and uninsured Americans will go down."

Health policy specialists expected the number of uninsured Americans to grow, but many expressed surprise at the breadth and depth of the increase. Not since 1992 has the nation experienced such a steep drop in health coverage, an issue Bill Clinton capitalized on in his successful campaign against President George H. W. Bush.

The most startling story line behind the census figures is the ongoing loss of health benefits in the workplace. For the second year in a row, the proportion of people who received insurance through an employer fell, from 62.6 percent in 2001 to 61.3 percent last year. Cost appeared to be the primary reason. "Employment-based coverage is getting really expensive," said Kate Sullivan, director of health care policy at the US Chamber of Commerce. "Either the company doesn't make it available or individuals are turning down coverage at work because they can't afford it. That's very alarming."

The average cost of a family health plan rose from $8,000 in 2002 to more than $9,000 this year, and is expected to exceed $10,000 in 2004, said Helen Darling, president of the Washington Business Group on Health, which represents 180 major corporations.

"When you think about the average wage in this country being only $27,000, somebody's going to say, `Wait a minute, I can't afford an employee at that level,' " she said.

It wasn't just low-wage workers who struggled to afford health coverage, said Sullivan, noting that 900,000 full-time workers lost their insurance in 2002. "The number of people earning over $50,000 without coverage is rising," she added. "This shows they're not immune."

Were it not for the growing numbers of people who either bought their own insurance or enrolled in a government-subsidized program, the total number of uninsured Americans would have been 2.9 million greater, the data show.

A state study released earlier this year found that 6.7 percent of Massachusetts residents were without insurance in 2002, up from 5.9 percent in 2000.