Fewer Workers Have Health Insurance : Workplace: Only 57% of the employed had coverage through their companies in 1990, down from 59% in 1988. Rising costs have forced many firms to reduce benefits.

The number of Americans without health insurance grew by 1.4 million to 35.7 million, or 16.6% of the non-elderly population, between 1989 and 1990, according to a study released Wednesday. The study also provided fresh evidence that the inability of workers to get coverage through their jobs is swelling the ranks of the uninsured.

About 84% of people without insurance nationwide live in families headed by employed persons, according to the report issued by the Employment Benefit Research Institute, a nonprofit group in Washington. Only 57% of workers were able to get coverage through their employers in 1990, down from nearly 59% in 1988, reflecting increased unemployment and cutbacks on health care coverage by employers hit by insurance costs rising 36% over the past two years.

“It’s affecting higher-income people now, not just the poor. People who vote and make more money are affected now,” said Jill Foley, author of the report.

The study gives the most up-to-date picture available of America’s uninsured population, and could provide ammunition for Democratic candidates assailing President Bush’s record on health care just days before he is to make a State of the Union address highlighting his plan for improving America’s medical system.

The study found that while more and more working- and middle-class people are without insurance, the very poor have benefited from expansion of Medicaid coverage. The elderly are covered by Medicare.

California alone accounted for 40% of the increase in the number of uninsured nationwide. About 746,000 more residents were without coverage compared to the prior year for a total of 5.8 million, or 22.1% of the state’s population, up from 21.9% in 1989, according to the report.

While a number of states, including Hawaii, Texas and Kentucky, have significantly reduced the proportion of their residents who are uninsured, California’s situation continued to get worse.

California ranked 43rd in terms of the percentage of the population with health insurance--down from 40th place in 1988--sharing the bottom rungs with such poor states as Louisiana and Mississippi.

Although it is among the nation’s most wealthy states, Californians fared poorly in the study because so many of its residents work in industries with skimpy insurance coverage--services, retail, construction and agriculture. About 39% of agricultural workers and 24.2% of retail workers have no health insurance. And employment at large manufacturing firms, which tend to have good insurance benefits, is shrinking.

Jacque Sokolov, medical director of Southern California Edison, noted that while 90% of California’s growth has been in small firms, “this type of growth is not conducive to insurance. Only half of small firms provide health insurance.”

Nationwide, nearly half of all uninsured workers are either self employed or working in firms with fewer than 25 employees.

Calls for national health care reform could be bolstered by the study’s finding of wide disparities among states in health care coverage--ones that correlated more with types of industry and state policies than income levels.

Southern and Southwestern states had the worst health care coverage, in part because they depend heavily on service, retail and construction industries that tend to not provide insurance, and in part because they have large Latino populations, which tend to have less health insurance than other ethnic groups, regardless of income level. The study found 34.8% of all Latinos went uninsured, compared to 13.1% of whites and 22.8% of blacks.

Northeastern and Midwestern states with a strong base of large, unionized manufacturing companies had the best coverage. For example New York, though it shares with California big-city problems and large numbers of poor people, had only 14.4% of its people without insurance.

One of the most significant findings of the study was that while fewer working people are able to get insurance through their employers, Medicaid is expanding coverage for the very poor.

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