White House Message: The Uninsured Are Just Like Us : Health care: Administration is intent on showing that the problem affects those with jobs, children.

Whenever President Clinton talks about providing health insurance for those who do not have it, many Americans mistakenly think he is promising help for the unemployed, the poor and the elderly.

In truth, most of the estimated 37 million citizens currently without health insurance have jobs, earn enough to keep them above the poverty level and have not yet reached their 30th birthday.

Rather than being a hard-core, permanent group, they are an ever-changing collection of people, most of whom find coverage within a short time after losing it.

The true makeup of the uninsured population is emerging as a key element in the health care debate primarily because Clinton is expected to propose a stiff new tax to provide insurance for them. His proposal is based, in part, on the premise that without universal health insurance, these Americans do not receive adequate care.

Advocates for the uninsured say Clinton’s plan will solve a serious national problem--ending the severe hardships imposed on workers with sick children whose employers do not provide coverage and those who cannot get insurance because they have a serious medical condition.

But as health care experts have studied the problem of the uninsured, some are beginning to question why Clinton wants to spend scarce tax dollars to provide insurance for many people who are not necessarily impoverished or being deprived of care. In fact, some conservatives say they believe that the President is simply exaggerating the seriousness of the problem.

John Sheils, a health care consultant for the research firm of Lewin-VHI, notes that many uninsured people find coverage within a few months after losing it, most are getting medical treatment and some have simply decided that insurance is not a good economic bargain for them.

“We’ve never seen the uninsured march on Washington,” Sheils said. “But if we start making everyone buy insurance, the uninsured may just march on Washington. A lot of them don’t want it, they don’t want to pay for it.”

Yet Clinton’s proposal for covering the uninsured may be gaining support because many middle-class people fear that they might lose their insurance someday.

Two in five Americans tell pollsters that they are either uninsured or concerned about losing their health coverage. The Robert Wood Johnson Foundation, which funds health care research, has identified this group as “a core constituency for reform.”

“If people know that the uninsured are people more like they are, then it gets more support than if they think they are helping the less fortunate,” said Harvard University’s Robert Blendon, an expert on public opinion and health care who advises the President and First Lady Hillary Rodham Clinton, who heads the Administration’s health care reform task force.

Blendon said that explains why Hillary Clinton often tells her middle-class audiences that the uninsured “are people just like us.”

As Blendon sees it, the success of Clinton’s health care reform proposals could depend on whether the Administration is able to persuade most Americans that the plan for universal coverage can potentially help everyone, and not just those who normally depend upon government benefits.

Public misconceptions about the uninsured were recently documented in a public opinion survey financed by the Robert Wood Johnson Foundation. When asked to characterize the uninsured, 48% of those surveyed pointed to the poor, 37% said the unemployed and 35% said the elderly. Only 10% thought the uninsured included working families.

But census data shows that in 1991, 85% of the uninsured lived in households headed by either full-time or part-time workers, nearly three-fourths live in households earning more than $10,000 a year and more than half were under the age of 30. One in 10 lives in a family earning more than $50,000 a year.

In reality, the poor, the unemployed and the elderly do not make up a large portion of the nation’s uninsured population because most of those people are receiving care under Medicare or Medicaid.

By and large, the uninsured are people who fall economically between two extremes--not poor or old enough to collect government benefits, but not fortunate enough to work for an employer that can afford to provide health insurance benefits.

They include recent high school and college graduates, small-business employees, farmers and other self-employed workers, and children dependent upon uninsured workers.

Under the health care reform proposal that Clinton is preparing to send to the Congress, the government is likely to impose a new payroll tax on employers and their workers to finance universal coverage. Experts estimate the cost of covering all Americans at between $50 billion and $90 billion.

But opponents of universal health insurance coverage say the problems of the uninsured are not bad enough to warrant an expensive new program. Sheils said the worst hardships could be eliminated by simply funding more health clinics and barring insurance companies from rejecting people with pre-existing health problems.

In a study often cited by opponents of universal coverage, Katherine Swartz of Harvard’s School of Public Health found that about 15% to 19% of the uninsured go without coverage for more than two years. She also found that 48% obtained coverage within five months after losing it.

Likewise, the Employee Benefits Research Institute, a research group, estimates that while about 45 million people will lack health insurance at some point during the year, only about 25 million will go without health insurance for the entire year. These estimates are based on census data, which does not seek to include illegal immigrants.

Most people who temporarily lack coverage are those who lose their jobs and then find new ones within a few months, experts say. Once rehired, many workers do not receive benefits until they have completed a probationary period, often as long as six months to a year.

Young, uninsured workers are most likely to be unconcerned by their lack of coverage because they are relatively healthy and experience few medical emergencies, experts say.

Many share the attitude of John Kutac, 23, a University of Texas student who works as a part-time waiter and is not enrolled in his company’s health insurance plan.

“If I wind up in the hospital,” he said, “it will be because of something somebody else did, and they will have to pay.”

In addition, Edmund Haislmaier, senior policy analyst for health care issues at the conservative Heritage Foundation, noted that many self-employed workers, such as farmers, would rather pay their medical bills themselves because insurance would cost them more money.

“When you have to bear the cost of health insurance out of your own pocket, particularly if you have an irregular cash flow and are relatively healthy, it may not be so stupid to go without health insurance,” he said.

Writing on the Op-Ed page of the Wall Street Journal recently, William Bates, a self-employed computer software expert, said he saves money by shopping for cheap medical care instead of buying insurance. Universal insurance, he argued, eliminates incentives for cutting health care costs.

“Just an attempt at negotiation with a doctor or dentist reveals that prices in this industry are stuck at inflated levels because insurance foots the bill,” Bates wrote.

Yet even critics of universal health insurance acknowledge that many people are deprived of insurance they want and need.

“There are enough of these nightmare scenarios that you cannot simply dismiss the problem of the uninsured as silly,” Sheils said.

There are many people, such as Gayle Sanchez, for whom the loss of health insurance has been a traumatic experience. Sanchez, 45, a self-employed dentist and father of three children in Baton Rouge, La., has not been able to get insurance at any price since he survived a bout with cancer in 1989.

“After Gayle’s illness, I asked an independent insurance agent if there was anybody who would write a policy on Gayle, and he said: ‘You have got to be kidding,’ ” said Sanchez’s wife, Belinda.

Perhaps the saddest stories are those of the children of working parents who go without necessary care.

The Employee Benefit Research Institute estimates that 9.5 million American children lacked insurance in 1991.

Insurers are often wary of covering workers with sick children.

Donna and Gary Deaver, owners of Sparky’s Waste Control in Springfield, Mo., say they cannot buy affordable health insurance for their 11 employees because one of them, Larry Allen, has a son with cerebral palsy. They recall being told by one insurer that they could get coverage more easily if they would fire Allen, which they refused to do.

As a result, Allen’s son, Jeremy, has been forced to rely primarily on charity fund raising to obtain care, Donna Deaver said. The boy recently had an operation funded, in part, by the local Shriners.

The debate over the uninsured often ignores a second tier of need--millions of Americans whose health insurance does not cover serious illnesses.

According to the Families USA Foundation, which supports universal health insurance, more than 11% of the nation’s families include someone who will pay at least a tenth of their income for health care this year. They technically have health insurance, but their policies exclude serious illness.

Many insured Americans support universal coverage apparently because they realize that they already foot the bill for uninsured and underinsured people who are unable to pay when they seek emergency care at the nation’s public hospitals, experts say.

In 1991, it was estimated that hospitals dispensed $10 billion in care to people whose bills were not paid by insurance, and those costs were passed along to insured patients in the form of higher prices.

Contributing to the anxiety of many insured Americans are recent news accounts of longtime workers whose benefits were abruptly canceled, including 25,000 Unisys retirees who were notified last October that their company-paid health insurance program was being eliminated.

The retirees include such people as 64-year-old Frank Monteleone of Ft. Pierce, Fla., who took early retirement and is not yet eligible for Medicare. “Being hit with this is a big financial blow to me,” Monteleone said. “They have just pulled the rug out from under us.”

Administration officials are relying on such stories to demonstrate to middle-class Americans that their benefits are not secure.

* HEALTH CARE WOES: First Lady hears from workers who lack health insurance. A17

The Uninsured: Who They Are

Most of those without health insurance are from working-class families. Here is a profile of America’s uninsured: FAMILY INCOMES Family incomes less than $20,000: 55% $20,000 to $50,000: 35% Above $50,000: 10% UNEMPLOYED Employed or children: 83% Unemployed adults: 17% RACE OR ETHNICITY Anglo: 58% Latino: 19% Black: 18% Other: 5% SIZE OF EMPLOYER Work for firms employing less than 25 people: 35% 25-99 workers: 16% 100-999 workers: 15% 1,000 or more: 21% Self-employed: 13% SEX Male: 56% Female: 44% WHERE THEY LIVE Urban: 78% Rural: 22% Sources: Employee Benefits Research Institute, March 1992 figures; Associated Press