Uninsurance numbers show need for U.S. health reform: Poverty rate grows
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* Kim Krisberg

With the prospect of health reform looming, the U.S. Census Bureau in September reported that America’s uninsured numbers have bounced back above the 46 million mark, with private and employer-based coverage continuing its eight-year trend downward.

Released as part of the bureau’s “Income, Poverty and Health Insurance Coverage in the United States: 2008” report, officials tallied the number of America’s uninsured at 46.3 million in 2008, up from 45.7 million in 2007. Though uninsured numbers rose, the percentage of uninsured Americans, at 15.4 percent, did not statistically change from 2007 — a finding attributed to the second consecutive year of enrollment increases in public health care coverage such as Medicaid and Medicare, reported David Johnson, chief of the Census Bureau’s Housing and Household Economic Statistics Division, during a Sept. 10 news conference. Johnson noted that the 2008 uninsurance numbers, collected mostly in March 2009, only count respondents who said they had no coverage for the entire calendar year, and do not count the millions who typically go uninsured for only part of the year.

“We know that recent data indicate that 14,000 more people lose their health coverage each day,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). “That means that the 46 million individuals who were uninsured in 2008 will likely be joined by millions more before this year is over. The time has come for our nation to say enough. The number of uninsured Americans confirms that we have neither health nor economic security with our current health care system.”

Continuing an eight-year trend — and most likely compounded by the country’s current economic woes — the Census Bureau reported that the number of people with employer-based health coverage dropped to 176.3 million in 2008, down from 177.4 million in 2007 — a statistically significant change. Officials also reported a decrease in the percentage of people with private health insurance, from 67.5 percent in 2007 to 66.7 percent in 2008. The numbers of people with government health insurance rose in 2008 to 87.4 million, up from 83 million in 2007, with Medicaid enrollment increasing by 3 million and Medicare numbers rising by more than 1.5 million. Overall, the percentage of people covered by government health insurance increased to 29 percent in 2008, up from 27.8 percent in 2007. Pointing to higher U.S. unemployment rates in 2009, Ron Pollack, executive director of Families USA, noted that the 2008 census data “may substantially understate how many people lack health coverage today.”

“Based on previous analyses, each one percentage point increase in the unemployment rate means approximately 1.1 million additional people joined the ranks of the uninsured,” Pollack said. “As a result, the number of uninsured today is probably close to 50 million.”

One silver lining, however, was that the overall uninsurance rate for those younger than 18 was at its lowest point since 1987. In 2008, the number of children without health insurance was 7.3 million, an improvement from 8.1 million in 2007. Children living in poverty, however, are still more likely to go uninsured than children overall, the report stated. And again confirming the nation’s documented health disparity gap, the Census Bureau found that certain ethnic and racial groups as well as geographic regions bear an uneven burden of the ongoing uninsurance crisis. The Census Bureau reported a 19.1 percent uninsurance rate in 2008 among blacks, 17.6 percent among Asians, 30.7 percent among Hispanics and 10.8 percent among whites. The rates represent an increase for whites, a decrease among Hispanics, and a statistically stable rate for blacks and Asians. Geographically, the Northeast and Midwest are home to lower uninsured rates, at 11.6 percent each, than the West, at 17.4 percent, and South, at 18.2 percent. Such 2008 rates were not statistically different from 2007, except in the West, where the uninsured rate rose from 16.9 percent to 17.4 percent.

“Disturbingly, the uninsured numbers from the U.S. Census Bureau represent the tip of the problem,” said APHA’s Benjamin. “There are another 25 million underinsured people who also receive inadequate access to care and are at risk of many of the same outcomes as those with no coverage at all. This is unacceptable for a rich nation, it is unacceptable for a humane nation, it is unacceptable for a just nation.”

In addition to increases in U.S. uninsurance numbers, the Census Bureau also documented a rise in the nation’s poverty rate, with the 2008 rate of 13.2 percent the highest since 1997. In 2008, families living in poverty numbered 8.1 million, up from 7.6 million in 2007, with the poverty rates increasing for whites, Asians and Hispanics, while remaining stable among blacks. The poverty rate for children younger than 18 also went up, as it did for people ages 18 to 64, though it remained statistically unchanged for people ages 65 and older. Income took a downturn in 2008 as well, with the bureau reporting that real median household income declined by 3.6 percent from 2007 to 2008, with such a decline occurring among all racial and ethnic groups surveyed. According to the report, the 2008 income decline offsets income gains made in the previous three years and coincides with the economic recession that began in December 2007.

For the full census report and uninsurance numbers, which were released the morning after President Barack Obama’s health reform speech before a joint session of Congress, visit [www.census.gov](http://www.census.gov). To take action on health reform, including sending letters to members of Congress and the president, visit APHA’s advocacy page at [http://action.apha.org/site/PageNavigator/Advocacy](http://action.apha.org/site/PageNavigator/Advocacy).

*   Copyright The Nation’s Health, American Public Health Association