Number Without Health Insurance Rises

An unprecedented 42 million Americans now have no medical insurance, “a foreboding increase” from 39 million just three years ago when President Clinton launched his ill-fated crusade for universal health coverage, according to an analysis released Friday by the American College of Physicians.

The study by the country’s largest medical specialists group blamed the increase on the continuing decline in employer-provided coverage and on funding cuts for Medicaid, the $158-billion-a-year federal/state health program for the needy.

The problem is not confined to the poor, the organization said. A third of the uninsured live in households with annual incomes of more than $30,300--twice the federal poverty level for a family of four.

In a report titled “Universal Coverage: Renewing the Call to Action,” leaders of the 89,000-member organization said that the declining coverage was both a moral and an economic issue. They urged this year’s presidential candidates and private industry to address it.

The group also called for a public debate to explore alternatives to the nation’s employer-based health insurance system, which came of age after World War II but has been steadily shrinking in recent years as businesses retrench in the face of steep medical inflation.

The report, released in San Francisco at the organization’s annual meeting, could hardly be more timely. It comes at the start of the presidential campaign season, barely 18 months after Clinton’s massive agenda to overhaul the $1-trillion-a-year health care system collapsed and only a few months after Congress failed in its attempt to restructure Medicare--the $178-billion-a-year health program for the nation’s 37 million elderly.

Now, Congress is bogged down in partisan wrangling over an insurance reform bill that seeks to provide security to those already insured by making it easier for them to stay covered even after developing a serious illness or leaving a job.

That legislation would be “a first step” toward reversing the rising tide of uninsured, said the physicians’ group, whose members are internists who provide the bulk of the nation’s adult medical care.

The group’s call for a reexamination of employer-based health coverage is particularly intriguing when viewed through the prism of the 1996 presidential campaign, in which health care reform is likely to be an issue.

The president’s original health reform proposal went to great lengths to preserve employment-based coverage. Indeed, it sought to require all businesses to provide insurance to workers--a colossal mandate that was soundly rejected.

Senate Majority Leader Bob Dole of Kansas, the presumptive GOP presidential nominee, is fighting to enact tax-exempt medical savings accounts--a device that, if put in place nationwide, would weaken the link between workers’ health insurance policies and their employers.

Medical savings accounts, promoted by free-market Republicans, would allow a person to open an individual, tax-deferred bank account and draw from it to pay for routine medical services until a high-deductible catastrophic insurance plan kicked in.

About 62% of Americans under age 65 currently receive medical insurance through the workplace. In 1983, 66% of Americans under 65 received that benefit.

But the physicians’ study said that 12.5 million people, or nearly 9% of the population under the age of 65, lost employer-sponsored coverage between 1988 and 1993, the most recent years for which comparable data are available. In 1988, the estimated number of uninsured Americans was 33.7 million.

The study, prepared by the Urban Institute, a Washington think tank, also concluded:

* Lack of insurance is associated with a 25% higher risk of death. This finding was based on a 16-year study of 700 uninsured persons.

* Uninsured children who are injured were only 73% as likely as insured children to receive treatment.

* In addition to the 42 million uninsured Americans, another 29 million (or 18.5% of those under age 65) are underinsured, meaning that they could not afford out-of-pocket medical costs that exceed 10% of family income.

“The data show that lack of insurance is like a disease itself,” said Dr. Gerald E. Thomson, president of the group of internists. “As physicians, we cannot accept this threat to the health of our patients.”