The New York Times on the Web
September 26, 1998
WASHINGTON -- Despite the booming economy, the number of people without health insurance rose sharply last year, to 43.4 million, and the proportion of Americans lacking coverage reached the highest level in a decade, 16.1 percent, the Census Bureau reported Friday.
After rising slightly more than 1 million a year, on the average, in the last decade, the number of uninsured people was up 1.7 million last year, the largest increase since 1992.
Medicaid rolls are down, and some employers have said they are cutting back health benefits, especially for dependents of employees.
Robert Bennefield, a statistician at the Census Bureau, said the data were somewhat surprising. "In a healthy economy," he said, "you'd think you would have more people with jobs, and that would tend to increase coverage, so you'd see fewer people uninsured."
Even people with higher incomes are going without insurance. Households with annual incomes of $75,000 or more accounted for half the increase in the number of uninsured, the bureau said. The number of people in these upper-income households without insurance rose last year by 852,000, to 4.9 million.
The Census Bureau said that 8.1 percent of these higher-income households were uninsured last year, up from 7.6 percent in 1996.
The number of poor people without insurance stayed about the same, 11.2 million. Nearly one-third of all poor people -- 31.6 percent -- were uninsured last year, about the same as in 1996.
Expanding health coverage has been a top priority for President Clinton since he took office in 1993. Since his proposal for universal health insurance died in September 1994, he has announced dozens of initiatives to achieve that goal. But he has been unable to stop the erosion in coverage, and Congress, which has passed several laws to provide health benefits in recent years, appears unlikely to do anything more in the near future.
Administration officials maintain that the situation would be even worse without their efforts to guarantee coverage for children and for workers who change or lose their jobs.
The Census Bureau said that 10.7 million children were uninsured last year, about the same number as in 1996. Because of Medicare, virtually all people 65 and older have insurance coverage. So it was people 18 to 64 who account for the increase in the uninsured.
People 18 to 24 are least likely to have coverage, the bureau said. Thirty percent of these young adults were uninsured last year, up from 28.9 percent in 1996.
Hispanic Americans had the highest chance of being uninsured. Thirty-four percent of Hispanic people lacked insurance last year, compared with 21.5 percent of blacks and 12 percent of non-Hispanic whites.
The Census Bureau had been planning to issue a report on the data on Monday. But the raw data were posted on the Internet on Thursday. A small organization of doctors tabulated and analyzed the data and issued its findings Friday.
"What's startling is the magnitude of the increase when the economy was booming," said Dr. Steffie Woolhandler, a co-founder of the organization, Physicians for a National Health Program. The group advocates universal access to health care.
Census officials and health policy experts suggested several reasons for the growth in the number of uninsured:
-- Welfare rolls have been shrinking for several years. People on welfare automatically got Medicaid. But when they leave welfare, they often take low-paying jobs with no health benefits. These workers or their children may still be eligible for Medicaid, but they do not realize it.
-- Small businesses are creating most of the nation's new jobs. But these businesses are far less likely than big companies to provide health insurance.
-- Health care costs and insurance costs are on the rise again. Cost is the reason most often cited, by individuals and employers, for not buying insurance.
Diane Rowland, executive director of Kaiser Commission on Medicaid and the Uninsured, said: "We are in a time of transition and turmoil in welfare. While many states are trying to simplify Medicaid enrollment procedures, there are still many barriers. Case workers seem to be under greater pressure to find people jobs than to assure they have health insurance coverage."
New York City has begun inspecting the homes of some people who apply for Medicaid, to see if they misrepresented their income, assets or living arrangements. City officials defend the technique as a way to prevent fraud, but some advocates for the poor say it is one more obstacle to getting health insurance.
Ms. Rowland said that changes in welfare and immigration law had deterred some people from applying for Medicaid. "Noncitizens often shy away from enrolling in Medicaid," she said. "And noncitizen parents may be reluctant to seek Medicaid even for children who were born in this country and are eligible for Medicaid as citizens."
The Census Bureau's report is based on interviews with 50,000 households chosen to be representative of the nation as a whole.
The bureau said that 10.8 percent of Americans reported having Medicaid coverage last year, down from 11.8 percent in 1996. The number of people on Medicaid declined by 2.5 million, to 29 million, the bureau said.
Some people who have insurance are unaware of it and do not report coverage, the bureau said. But such underreporting has affected federal surveys for years and would not explain the increase in the uninsured last year, officials said.
The government said that 43.3 percent of the poor were covered by Medicaid at some time last year, down from 45.5 percent in 1996.
Many poor people do not qualify for Medicaid. Many states set income limits far below the poverty level. Childless adults are often ineligible even if they are very poor.
The Census Bureau found that the number of people with employer-sponsored health
insurance rose last year, to 165.1 million, from 163.2 million in 1996. More people are
working, and employers may be providing health benefits for some of those workers, even as
they eliminate benefits for some dependents.