Jump in uninsured signals need to implement health reform: Economy takes a toll on health coverage
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* Kim Krisberg

In the wake of the nation’s economic downturn and its impact on access to health care, new Census Bureau figures show the U.S. uninsured rolls topped 50 million people in 2009 — the largest number of uninsured since federal officials began collecting such data.

In 2009, U.S. uninsured numbers rose to 50.7 million, up from 46.3 million in 2008 and translating to an uninsured rate of 16.7 percent, up from 15.4 percent in 2008, according to “Income, Poverty and Health Insurance Coverage in the United States: 2009,” which the U.S. Census Bureau released Sept. 16. The percentage of people with employer-based health coverage continued its downward trend to less than 56 percent in 2009, down from more than 58 percent in 2008 — a decline that puts the employer-based insurance rate at its lowest point since 1987, the Census Bureau reported.

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[Figure1](http://www.thenationshealth.org/content/40/9/1.1/F1)

Volunteer Jennah Hanos, left, talks to patient Jackie Simmons, right, and her granddaughter, Paige Simmons, at a free medical clinic for the uninsured in New Orleans in August.

Photo by Mario Tama, courtesy Getty Images

“Having access to quality, affordable health care should be a basic right, not a privilege for all Americans, yet the bleak data paint a different picture,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E), in an Association news release. “Our health care system has been failing the American public for too long. Unfortunately, given the economic downturn and anemic job market, even more Americans could face the desperate plight of losing their insurance down the road. The record number of uninsured Americans underscores the need to fully implement every single lifesaving provision included in the new health reform law.”

In a bit of a silver lining, public health insurance programs again helped buffer the impact of insurance loss. The Census Bureau reported that the number of people covered by government health insurance rose from 29 percent in 2008 to more than 30 percent in 2009, with Medicaid enrollment rising from 42.6 million people in 2008 to 47.8 million people in 2009, while Medicare numbers remained stable. Also, even though the child poverty rate also rose in 2009, the rate of children younger than 18 without health insurance was not statistically different from 2008 — news many health advocates attribute to the success of programs such as the State Children’s Health Insurance Program.

While all U.S. income groups have higher uninsurance rates than in 1987, when the Census Bureau began collecting such data, significant disparities remain. The 2009 uninsured rate among Hispanics was more than 32 percent, up from more than 30 percent in 2008, and the rate increased from more than 19 percent to 21 percent among blacks. The rate for Asians remained about the same at about 17 percent, and the uninsured rate among whites rose to 12 percent, from more than 10 percent in 2008.

Regarding age groups, the percentage of people younger than 65 without insurance rose in 2009 to almost 19 percent, up from more than 17 percent in 2008, while the rate for those older than 65 as well as those younger than 18 remained stable. Not surprisingly, Americans living on lower incomes have higher uninsurance rates than their higher-salaried counterparts, with more than 26 percent of those in households with annual incomes of less than $25,000 being uninsured in 2009, compared to 16 percent in households with incomes from $50,000 to $74,999 and about 9 percent in households with incomes of $75,000 or more, according to the Census Bureau report.

“This is a huge jump (in uninsurance) and it is unprecedented,” said Ron Pollack, executive director of Families USA, a health care consumer advocacy organization. “But one of the key subtexts of the story is that the public safety net programs played a heroic role by substantially expanding coverage. Had they not done so, this huge increase would have been far, far worse.”

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[Figure2](http://www.thenationshealth.org/content/40/9/1.1/F2)

Sulema Aleman and her daughter, Deborah Aleman, receive wristbands guaranteeing them a chance to see a doctor at a free clinic in Los Angeles in April. About 1,200 people a day received care at the week-long event.

Photo by Robyn Beck, courtesy AFP/Getty Images

While provisions in the new health reform law will provide some immediate relief, such as enabling young adults to remain on their parents’ insurance plan, the biggest help will come in 2014, Pollack told *The Nation’s Health,* when health reform is fully implemented.

“Obviously, when more people return to the job market, it is going to help,” he said. “But I think that (health reform) really provides the greatest hope to substantially reduce the number of uninsured.”

Edwin Park, JD, co-director for health policy at the Center on Budget and Policy Priorities, noted that even without the recession, which contributed to the statistics, uninsurance rates would still have ticked upward.

“The trends have been very consistent since the start of the decade,” Park told *The Nation’s Health.* “It’s certainly worse during down years…but you can’t explain away these long-term trends with the recession. We saw increases (in the uninsured rate) even when the economy was good.”

In other new Census Bureau statistics, the agency reported that the U.S. poverty rate increased to more than 14 percent in 2009, up from a little more than 13 percent in 2008, with the number of people living in poverty the largest in the 51 years for which poverty estimates have been published (see related story). Also, real median income declined by almost 2 percent from 2008 to 2009 for family households, but increased by more than 1 percent for other households. Overall, real median income declined for white and black households, while remaining stable among Asian and Hispanic households.

For more information or to download a copy of the new Census Bureau report, “Income, Poverty and Health Insurance Coverage in the United States: 2009,” visit [www.census.gov](http://www.census.gov).

## Census Bureau: Millions more Americans falling into poverty

More than 43 million people were living in poverty in the United States in 2009 — an increase of about 4 million people and the largest number in more than five decades — the U.S. Census Bureau reported in September.

The official U.S. poverty rate rose to 14.3 percent in 2009, up from 13.2 percent in 2008, according to the agency’s “Income, Poverty and Health Insurance Coverage in the United States: 2009” report. While the poverty rate rose for whites, blacks and Hispanics, it remained stable among Asians. The report noted that the increase in the nation’s overall poverty rate was larger than the rate increase during the 1973–1975 recession, but smaller than during recession periods from 1980 to 1982.

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[Figure3](http://www.thenationshealth.org/content/40/9/1.1/F3)

Photo courtesy Mark Strozier, iStockphoto

“Even before the recession hit, middle-class incomes had been stagnant and the number of people living in poverty in America was unacceptably high, and today’s numbers make it clear that our work is just beginning,” said President Barack Obama in a White House news release.

Among people ages 65 and older, the poverty rate decreased from 2008 to 2009, from 9.7 percent to 8.9 percent, but increased among children 18 and younger and for those ages 18 to 64. Among children ages 18 and younger, the poverty rate rose from 19 percent to more than 20 percent. The new child poverty numbers, at more than 15 million in 2009, mean more than one in every five U.S. children lives in poverty, according to the Children’s Defense Fund.

“Congress must help parents get back to work and maintain the additional support they are now receiving until they get back on their feet,” Stefanie Sprow, a policy staffer at Children’s Defense Fund, told *The Nation’s Health.*

Sprow called on congressional policy-makers to expand unemployment benefits as well as reauthorize the Temporary Assistance for Needy Families program, which was scheduled to expire in late September despite its success at creating hundreds of thousands of short-term jobs for low-income parents.

For more on the Census Bureau poverty numbers, visit [www.census.gov](http://www.census.gov) or [www.childrensdefense.org](http://www.childrensdefense.org).

— Kim Krisberg

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