Providers, consumer groups and policy analysts expressed dismay over the news last week from the U.S. Census Bureau that the ranks of the uninsured grew by 682,000 people nationwide to 46.3 million uninsured, and said that the figures show the urgency of enacting healthcare reform.
Adding it all up
Some caution uninsured figure could be too low
Perhaps most alarming is the continued downward trend of employer-sponsored coverage, which has been on a slide for the past eight years, according to the Census Bureau. Officials from the bureau said the number of uninsured would have been higher if not for government-sponsored programs such as Medicare and Medicaid.
Indeed, the rate of uninsured remained statistically unchanged over the year, at 15.4%. Native-born citizens made up 73.5% of the total uninsured last year, while 20.5% were noncitizens. Naturalized citizens accounted for 6% of the uninsured, according to the Census Bureau.
Still, nearly 1 million fewer people had job-based insurance last year than in 2007, or 58.5% of residents, down from 59.3% in 2007.
Meanwhile, 87.4 million people, or 29% of the population, were covered by government programs, up from 83 million people, or 27.8%, the prior year.
About one-fifth of adults under age 65 were without health benefits last year, up from 19.6% in 2007, according the U.S. Census’ annual report, Income, Poverty and Health Insurance Coverage in the United States: 2008.
Robert Greenstein, executive director of the Center on Budget and Policy Priorities, called the figures “grim” and said they would likely be worse in 2009 because of ongoing job losses and the dragging recession. “We think in ’09 there will be a much bigger jump,” Greenstein said.
If a person had insurance at any point in 2008, the Census Bureau counted that person as insured. So, for instance, if a worker lost his job and health coverage in late 2008 and remains uninsured today, he would have been counted as insured in the Census tally, according to Census officials. “Even these numbers may be an understatement of the individuals affected by the severe and ongoing recession,” said Karen Davis, president of the Commonwealth Fund.
For providers, the numbers were disappointing but no surprise.
Lloyd Dean, president and CEO of Catholic Healthcare West, said the system is seeing more people coming through the doors as newly uninsured. “For me, this just illustrates why healthcare reform in this country is desperately needed,” Dean said of the Census numbers.
Income mattered when it came to health coverage. Last year, nearly a quarter of people with incomes of less than $25,000 annually were uninsured, while 21.4% of people with household incomes between $25,000 and $49,999 were uninsured. Just 8.2% of households with incomes of $75,000 or more were uninsured.
A bright spot in the Census report was a drop in the number of uninsured children, to 7.3 million children last year. That’s down from 8.1 million uninsured children in 2007, and the lowest level since 1987, when the U.S. Census Bureau began collecting the data.
Children’s advocates said there is a direct correlation between access to affordable programs such as Medicaid and the State Children’s Health Insurance Program and the decline in uninsured children.
More children qualified for government-sponsored coverage perhaps because household income fell and poverty rose. Last year, the number of children under age 18 living in poverty increased by nearly 750,000 to 14.1 million, according to the bureau, which defines poverty as a family of four living off less than $22,025 annually.
“Children shouldn’t just have access to insurance when their family’s income drops below a certain level,” said Lindsey Wade, senior policy associate for the Children’s Defense Fund.
Sliding incomes amid the ongoing recession would make healthcare reform more expensive because more Americans would qualify for subsidies and public programs, Greenstein said.
Last year, U.S. real median household income fell 3.6% over the prior year to $50,303 from $52,163, while the 2008 poverty rate was 13.2%—the highest since 1997, the Census Bureau reported. “We now fully expect that the number of people in poverty will likely hit a 52-year high in 2009,” Greenstein said, adding that he predicts the number of uninsured to approach the 50 million mark sometime this year.
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