Uninsured count jumps to 47 million

Washington -- A persistent slide in work-based health insurance is largely to blame for a 2.2 million rise in the number of uninsured in America, according to policy experts.

U.S. Census Bureau figures released Aug. 28 show that the number of people without coverage increased to 47 million from 2005 to 2006.

The jump is "appalling," said American Medical Association President-elect Nancy H. Nielsen, MD, PhD. "I was so disappointed, because we have had years of people talking about this problem."

The percentage of people covered by insurance they get through work fell from 60.2% in 2005 to 59.7% in 2006, the Census Bureau figures show. The bureau's data approximate the number of people who are uninsured at a point in time during the year, as opposed to lacking insurance for the entire year.

"Overall, the picture is one of continual erosion of employer coverage that is now starting to squeeze the middle class," said Karen Davis, PhD, president of the Commonwealth Fund, a foundation dedicated to improving health care. "It's very troubling to see this dramatic increase."

The private insurance percentages fell because workers cannot afford premiums, said Paul Fronstin, PhD, director of health research and education at the Employee Benefit Research Institute. The Kaiser Family Foundation's annual employer survey last year found that the percentage of businesses offering coverage did not change, he said. But premiums rose 7.7%, while worker earnings increased only 4%.

"You have a disconnect between premium and wage increases," Dr. Fronstin said.

Dr. Davis noted the sharp increase of uninsured people with incomes between $25,000 and $75,000 a year. Even families that earn more than $100,000 a year have a hard time paying health care premiums that cost $1,000 a month, she added.

Figures showing that economic and job growth is strong mean that the increase in people without insurance is part of a long, troubling trend, Dr. Davis said. The ranks of the uninsured have grown by almost 8.6 million since 2000.

The latest Census data mean that patients will get sicker as they delay treatment, said the AMA's Dr. Nielsen. Physicians will have to offer even more charity care than they do now, she added. The cost of uncompensated care is approximately $100 billion a year across the health system, according to the Association.

Dr. Nielsen has a personal connection to the issue. She and her husband could not afford health insurance for their two children during the three years she was in graduate school. They once had no money to feed their kids for the rest of a month after taking their daughter to an emergency department for a 106-degree temperature, forcing them to seek help from her parents. "I have never forgotten it."

The increase in the number of people in America lacking coverage makes the AMA's Voice for the Uninsured campaign "absolutely urgent," Dr. Nielsen said. The campaign will spend $5 million by the end of 2007 for print and television ads highlighting the plight of the uninsured and demanding that presidential candidates prepare policies to address it.

"We want everyone, particularly voters in early presidential primary states, to make sure they ask candidates what their plan is to reduce the nhe said.

Dr. Nielsen urged physicians to log on to the campaign's Web site (link) and submit their personal experiences. The Web site asks people to share stories of how a lack of health insurance has affected their well-being or that of their family or their friends. The Association also provides educational materials for patients.

Other health policy experts were concerned about the increase in the number of uninsured.

"These are 47 million people like you and me who need help," said American Hospital Assn. Senior Vice President for Policy Carmela Coyle. "They need the same highly skilled physicians and nurses and hospitals to be there for them, and it is unfortunate for the hospital field that we do not have coverage for all in America."

Hospitals have long worked within their communities to help those in financial need, she said. "As the number of uninsured grow, hospitals can only do so much without risking their own viability."

All signs suggest that the count will continue to rise, Coyle added.

The Census Bureau data on children's health insurance intensified the debate over reauthorization of the State Children's Health Insurance Program. The number of children without health insurance increased from 8 million in 2005 to 8.7 million in 2006, primarily because fewer received coverage from employer-sponsored plans.

The data led to a new wave of congressional calls for President Bush to reverse an Aug. 17 Centers for Medicare & Medicaid Services decision to restrict states' ability to expand SCHIP eligibility beyond children from families earning 250% of the federal poverty level.

"I hope this sobering Census data will convince the administration to reverse recently imposed policies that will cause thousands more children to lose coverage," said Rep. John D. Dingell (D, Mich.), chair of the House Committee on Energy and Commerce.

The numbers show that SCHIP must be renewed and expanded, said Rep. Frank Pallone Jr. (D, N.J.), who chairs the House Energy and Commerce health subcommittee.

"Clearly these disturbing increases over the last two years demonstrate a need to strengthen this important health care program that provides access to health insurance for our most vulnerable children," Pallone said.

Ranking Republican on the Senate Finance Committee Charles Grassley (R, Iowa) said the Census data support passing a bill that expands the program. "This should motivate the House and Senate to reauthorize SCHIP this fall. The Senate bill will insure a lot of kids who don't have health insurance. It'll keep others from losing insurance."

President Bush acknowledged the rise in the uninsured. "Containing costs and making health insurance more affordable is the best way to reverse this long-term trend," he said on Aug. 28. Congress should pass an administration proposal to give tax benefits for purchasing health insurance, he stated.