Boom Times Are Not Necessarily Healthy

44 million Americans lacked health insurance last year, federal survey finds

FRIDAY, Aug. 10, 2001 (HealthDayNews) -- Low inflation, low unemployment, robust economy --that should add up to more people having health insurance, right? Wrong, according to the latest survey released by the federal government this week.

The first half of last year was no improvement over the same period in 1999, says the report. About 44 million Americans, or 16.1 percent of the nation's civilian, non-institutionalized population, had no health insurance.

Although number crunchers don't view this as statistically different from 1999's figure of 15.8 percent, the latest number still means 1.2 million more people had no insurance coverage.

A sample group of 25,000 people were asked about their health-care use, how much they spent, sources of payment and insurance coverage. For the survey, people were deemed uninsured if they weren't covered by Medicare, Armed Forces-related insurance, Medicaid, other public programs or private insurance. People who only had coverage for a single service, like dental or vision care, or were insured only for accidents or specific diseases also were considered uninsured.

This annual Medical Expenditure Panel Survey was done by the federal Agency for Healthcare Research and Quality (AHRQ).

Even though the figures are flat, they speak volumes to health-care policy analysts, particularly since the economic downtown in the last half of 2000 has worsened this year.

"In looking at 2000, when the economy was still very robust and unemployment was low, this was sort of the best of times in terms of unemployment rates and underlying inflation," said Kenneth E. Thorpe, professor of health policy in the Rollins School of Public Health at Emory University in Atlanta, Ga. "If the number of uninsured haven't gone down in the best of economic times, what are we going to see this year and next year? I don't think that provides a lot of reassurance to individuals who thought if you let the market work on its own, you'd see some correction."

Age-wise, young adults between 19 and 24 had the lowest levels of health insurance, with a full third of that group lacking coverage.

ARHQ senior economist Jessica Vistnes said that could be the result of two contributing factors.

"They might view themselves as immortal, and they don't want to pay the high premiums," Vistnes said. "If they don't get it [insurance] through their employer and they have a health condition, it would be hard to get it through the individual market, and the premium would be very high."

The elderly had the highest level of health insurance, followed by children under 18; only about 14 percent of minors weren't insured. Coming next were those aged 35 through 64:only 16.1 percent had no coverage.

The report also highlighted the on-going health insurance concerns of the Hispanic community. While representing just 12.9 percent of the population younger than 65, Hispanics accounted for one-fourth of the uninsured, non-elderly population, a level that has stayed the same throughout the last decade. Both Hispanic men and women were much more likely to be uninsured than blacks or whites of either gender.

"There are huge racial and ethnic disparities," Thorpe said. "It has some real, important regional implications. A lot of city and county hospitals that have high percentages of Hispanic populations are finding themselves in dire financial straits trying to find ways to care for an ever-growing population of uninsured. It certainly is placing additional financial burdens on providers."

Single living was also a risk. When the survey looked at whether people were married, more than one-third of those who were uninsured had never been married, and about one-third of everyone under 65 who were separated were uninsured.

Although most Americans would agree that everyone should have health insurance, Thorpe said the question of who pays for it is a major stumbling block in the political health-care debate.

"Any proposal to expand health insurance would have individuals, employers and the federal government contributing," he says. "We haven't arrived at the apportions for those groups."

And as Americans open their mail boxes this summer and fall to receive their windfall tax checks, Thorpe adds that the tax cuts come at the price of any hope of real health-care reform.

"Bush presented himself as someone with a huge plan to cover the uninsured," Thorpe said. "The tax cut he proposed, and Congress passed, has virtually spent the entire surplus. Realistically, unless some changes are made to the tax bill or we find a way to finance it elsewhere, the Bush administration has taken [health insurance] out of the public debate for the next decade. Realistically, the money's not there. It's been spent."

What To Do

Curious about what the survey says? You can read the entire report at the Agency for Healthcare Research and Quality.

And if you're thinking about insurance for yourself, take a look at these tips from Health Insurance Association of America.

SOURCES: Interviews with Kenneth E. Thorpe, Ph.D., Robert W. Woodruff Professor and chairman of the Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, Ga.; Jessica Vistnes, Ph.D., senior economist, Agency for Healthcare Research and Quality; Aug. 7, 2001, 2000 Medical Expenditure Panel Survey
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