GOVERNMENT & MEDICINE

Number of uninsured down, but struggle continues

The booming economy has helped to decrease the number of uninsured Americans. Tax credits and federal health program expansions could help further, doctor groups say.

By Geri Aston, AMNews staff. Oct. 16, 2000. Additional information

Washington -- A 1.7 million drop in the number of uninsured Americans is good news, but not good enough, according to physician groups and health care analysts.

"It's fantastic that the number of patients with insurance has improved," said AMA Trustee Bruce A. Scott, MD. "To say the problem is solved is not correct. We still have a lot of work to do."

About 42.6 million Americans lacked health insurance last year, down from 44.3 million in 1998, new U.S. Census Bureau figures show. That is the first drop in 12 years.

The driving force behind the decrease was a rise in employment-based coverage, the Census Bureau reported. The number of people with work-based insurance rose from 168 million in 1998 to 172 million last year.

The economy forced employers to offer health benefits even though premiums were up, said Paul Fronstin, PhD, senior research associate at the Employee Benefit Research Institute.

Although the strong economy helped, it didn't do enough, said Diane Rowland, executive vice president of the Kaiser Family Foundation. "If this is the best a really tight economy can produce, then we have a problem that a tight economy can't resolve," she said.

The economy has remained strong this year, and that likely means that the upswing in insurance is continuing, Dr. Fronstin said.

But, he and others warned, any economic downturn would result in the number of uninsured Americans heading up again.

Another possible factor contributing to the drop in the uninsured rolls was increased enrollment in the State Children's Health Insurance Program, health analysts said. The 3-year-old state-federal program provides coverage for children in families with incomes too low to afford health insurance but too high to qualify for Medicaid.

Many states have begun to aggressively search for the millions of SCHIP-eligible children who are not enrolled.

That work has begun to pay off. The White House recently announced that 2.5 million children are enrolled in the program. Although the Census Bureau does not track SCHIP coverage, its figures do show that the percentage of uninsured poor children dropped from 25% to 23% between 1998 and 1999. Meanwhile, the percentage of uninsured near-poor children fell from 27% to 20%, White House documents show.

Many left behind

Despite the decrease in the number of uninsured Americans, the Census Bureau figures show that many groups of Americans still have difficulty obtaining insurance. For example:

• About 32% of poor people had no health insurance of any kind last year, despite the eligibility of many for public programs.
• More than 33% of Hispanics and 21% of African Americans were uninsured last year.
• About 24% of people in households with annual incomes below $25,000 went without insurance, compared with 8% in households with incomes of $75,000 or more.
• More than 33% of foreign-born people lacked health insurance, compared with 13.5% of the U.S.-born.

Although the number of uninsured Americans dropped across the board, "it doesn't mean everyone has an equal chance of having coverage," Dr. Fronstin said.

The fact that more than 42 million Americans went without insurance last year spurred renewed calls for action in the health care community.

"We need to find ways besides relying on a healthy economy ... to make insurance more affordable," said Rowland of the Kaiser foundation.

For example, expansions of Medicaid and SCHIP would help poor Americans obtain insurance, while federal income tax credits could be established to help moderate-income families purchase coverage, she said.

Those concepts have support among some physician groups. The AMA advocates creation of income-related tax credits to help people buy insurance, Dr. Scott said. The Association also calls for the development of "voluntary choice cooperatives" -- individuals and small groups joined together to achieve the insurance purchasing power that large groups enjoy.

The American College of Physicians--American Society of Internal Medicine favors tax credits for low-income people and the expansion of public health programs for the poor, said President Sandra Adamson Fryhofer, MD. The group also supports increased funding for efforts to find and enroll people already eligible for Medicaid and SCHIP.

"We know there are people out there who need it. They just don't know where to get it," Dr. Fryhofer said.

Patient protection implications

The numbers have factored into the ongoing congressional debate on managed care. The AMA used the news that the number of uninsured Americans fell even as health insurance premiums rose in its fight for passage of a patients' rights bill.

"The insurance industry's argument against the patients' bill of rights -- that the bill would raise the number of uninsured -- has now been shown to be yet another big lie," said Thomas R. Reardon, MD, AMA immediate past president.

Insurers argue that patient protection measures would increase insurance premiums and, thus, boost the number of uninsured Americans.

The sheer number of uninsured means that lawmakers should focus on making insurance more affordable rather than trying to pass patients' rights legislation, said Health Insurance Assn. of America spokesman Richard Coorsh. "The needs of the uninsured must not be relegated to election year rhetoric," he said.

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The number of uninsured Americans fell for the first time in 12 years. Number of uninsured (in millions):

1987		31.0
1988		32.7
1989 		33.4
1990 		34.7
1991 		35.4
1992		38.6
1993		39.7
1994 		39.7
1995		40.6
1996		41.7
1997 		43.4
1998		44.3
1999		42.6

Source: U.S. Census Bureau

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U.S. Census Bureau health insurance data (http://www.census.gov/hhes/www/hlthins.html)

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Additional information

Data: A healthy drop

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