Ranks of Those Without Health Insurance Swell

Despite the booming economy, the decline in poverty and the growth of employment, the number of people lacking health insurance continued to rise in 1998, according to a Census Bureau report released today.

An estimated 44.3 million Americans had no health insurance last year, up about 1 million from 1997, the report shows. However, because of population growth, the proportion of people who are uninsured--16.3%--was about the same as in the previous year, the Census Bureau said in its annual review of the subject.

In California, the health insurance shortfall is among the most severe in the nation. With more than 7 million people lacking health insurance, about 22.1% of the state’s population is covered by neither private nor government plans. That is a larger share of uninsured residents than in any state except Texas and Arizona.

Number of Uninsured Children Up Slightly

The Census Bureau found that, as in the past, the people least likely to be covered by health insurance included Latinos and the foreign-born, groups that are heavily represented in California.

“Those more likely to lack health insurance continue to include young adults in the 18- to 24-year-old age group, people with lower levels of education, people of Hispanic origin, those who work part time and people born in another country,” said Jennifer A. Campbell, the report’s author.

Of the 44.3 million uninsured people nationwide, about 11.1 million were younger than 18, up from 10.7 million last year. The Census Bureau said that increase was too small to reflect a statistically significant change in the status of children’s health care.

But an analysis of the data by a physicians’ group said it continued a trend of deteriorating coverage among children in recent years. According to Physicians for a National Health Program, a Chicago-based organization that supports comprehensive health care reform, the percentage of children not covered by health insurance has increased from 12.4% in 1992 to 15.4% in 1998.

The new data come as health care continues to occupy a prominent place in policy debates in Congress and on the campaign trail. The House this week is scheduled to debate legislation to give people new rights in dealing with their health maintenance organizations. Both Democratic presidential candidates--Vice President Al Gore and former Sen. Bill Bradley--have in recent weeks unveiled proposals to increase availability of health insurance, especially for children.

But none of the proposals being weighed is nearly as far-reaching as the health care overhaul proposed by President Clinton early in his first term. Since the failure of that plan, Clinton and Congress have pursued more modest initiatives, such as the Children’s Health Insurance Program, a 1997 initiative to encourage states to improve coverage of children and a 1996 law to make it easier for people to keep health insurance coverage when they change jobs.

Strong Economy Doesn’t Solve Problem

Advocates for broader health insurance reform say the latest statistics show that neither such incremental changes nor a booming economy is enough to solve the problem of people lacking health insurance.

“We are not going to outgrow the problem of uninsured Americans,” said Steffie Woolhandler, an associate professor of medicine at Harvard and a spokeswoman for Physicians for a National Health Program. “It’s persisting with the best economy we have seen in decades.”

Woolhandler said a major reason for the continued increase in the ranks of the uninsured is the drop in enrollment in Medicaid, the federal-state health care program for welfare recipients and other poor people. The 1996 overhaul of welfare moved many people off welfare and into jobs, but many of those low-paying jobs did not offer any health insurance or coverage they could afford.

According to the Census Bureau, the number of people covered by Medicaid dropped to 28 million in 1998, down from 29 million in 1997. And among poor people alone, 40.6% were covered by Medicaid in 1998, down from 43.3% of poor people in 1997.

One possible salutary effect of the booming economy: The number of people getting insurance through their employers is up, after declining for many years. The increase was not enough to make much of a change in the percentage of people who get insurance through their jobs. Still, employment remained the largest source of health insurance: 70.2% of all people get private insurance through their employers or unions, the Census Bureau found.

Among the major racial and ethnic groups, the Census Bureau reported that 35.3% of Latinos were without insurance--more than any other group. That may reflect the kind of jobs many Latinos hold, analysts said.

“Latinos, for the most part, are in jobs where their employers don’t provide health insurance, such as service industry jobs,” said Jennifer Malin, a Los Angeles oncologist who is a spokeswoman for the California Physicians Alliance.

What’s more, while 34% of all foreign-born people were without health insurance, only 14.4% of the U.S.-born population was uninsured.

Non-coverage rates varied among states, ranging from a low of 9% in Nebraska to a high of 24.5% in Texas. Comparing the average rates in 1997-98 with those of 1996-97, the Census Bureau found that the proportion of people without insurance dropped in eight states (Arkansas, Florida, Iowa, Massachusetts, Missouri, Nebraska, Ohio and Tennessee) and rose in 16 others, including California.