Despite the prosperous economy, the proportion of Americans without health insurance climbed to 16.1% last year, with Latinos having the highest uninsured rates, the Census Bureau reported Monday.
Nationwide, 43.4 million Americans lacked health insurance in 1997, up from 41.7 million, or 15.6% of the population, in 1996. The incidence of children under 18 without insurance remained unchanged near 15%, or nearly 11 million.
Some states have higher non-coverage rates than others. Rates range from 7.9% in Wisconsin to 24.4% in Texas, according to the census report. In California, the rate is 21.5%--meaning that more than 7 million Californians lack health insurance.
However, the percentage of Latino children without health insurance remained disproportionately high. Nearly 29% of Latino children were uninsured in 1997, in contrast to 19% of African American children and 11% of non-Hispanic white children.
"A lot of the Hispanic community is concentrated in sectors and industries that do not provide health insurance--the blue-collar jobs and the service-sector jobs," said Luis Arteaga, the interim executive director of the Latino Issues Forum, a San Francisco-based public policy and advocacy organization that follows health care trends.
"A second factor is that historically the Hispanic community has not participated in the government-sponsored health programs--it's partly because of distrust of government and, here in California, it's also due to the anti-immigrant feeling. Parents are afraid of being considered a public charge," Arteaga said.
And if parents do not have insurance, it is unlikely that their children will be covered, said Jane Delgado, the president of the National Coalition of Hispanic Health and Human Services Organizations. "Even in companies where they cover the workers, often they don't cover the families," Delgado said.
President Clinton in 1993 proposed a national health care system that would have guaranteed health insurance for every American. But his plan was rejected by Congress and much of the public. Since then, lawmakers have not backed any ambitious expansions of the health insurance system.
The major obstacle to the purchase of health insurance is cost. The problem is particularly severe among the working poor whose incomes are too high to qualify them or their children for government-subsidized health insurance but so low that they cannot afford to buy it.
"While we had a big reform debate several years ago with President Clinton's health plan, we haven't done much since to expand coverage," said Diane Rowland, the executive director of the Kaiser Commission on the Future of Medicaid, a nonprofit group that studies health care issues for low-income Americans.
The Health Insurance Portability Act, passed in 1996, has made it somewhat easier for people with preexisting medical conditions to move from one health insurance plan to another.
And it is too early to tell if the new Children's Health Insurance Program, which aims to help children whose families are just above the poverty line to afford insurance, will make much difference.
Among the most striking changes in the Census Bureau data, according to many health policy experts, was the 1.3-million-person increase in the number of uninsured adults of all races in the 18-65 age group. In part, this may be explained by the drop in the number of people who are insured through the federal government's Medicaid program, which provides health insurance for the poor and disabled.
The Medicaid rolls lost nearly 2.6 million people--about 8% of enrollees--in 1997, according to the census report, in part because many women forced off the welfare rolls--who previously were eligible for Medicaid--have taken jobs that do not offer insurance or that offer coverage that they cannot afford.
"Our numbers of uninsured patients are going up and our numbers of Medi-Cal insured patients are going down," said Sylvia Drew Ivie, executive director of T.H.E. Clinic for Women in Los Angeles. A year ago, about 60% of the clinic's patients were uninsured and 40% had Medi-Cal. Now, about 25% have Medi-Cal and 75% are uninsured, she said.
While some people leaving welfare for work are getting insurance coverage through new jobs, many appear to be falling through the cracks.
Indeed, the number of people covered through their employment is up but not enough to make any change in the percentage of people who get health insurance through jobs.
Perhaps the most surprising statistics in the report show that middle-income and high-income Americans are dropping insurance coverage. The number of people with annual incomes from $25,000 to $50,000 who were without insurance in 1997 rose by 900,000 over 1996.
And there was a similar increase in the number of uninsured with annual incomes above $75,000. Experts are at a loss to explain it.
"I'm not sure why there would be a drop," said Mark Hoyt, who heads the government health care group for William Mercer, a national health care consulting firm. "The only guess I'd have is that it would pertain to dependent coverage."
Some companies that offer health insurance to their workers do not extend the coverage to their spouses and children. Or, the family coverage is available but too expensive for employees to afford the cost of paying for their share of family plans. Generally family coverage costs three to four times that of an individual plan.