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Health Care Reform:

Health Insurance & Affordable Care Act

More Americans Have No Health Insurance

Census Bureau Report Shows Slight Increase in Uninsured in 2008

More Children Have Health Insurance

The health insurance data, meanwhile, show some good news: a significant decline in the number of children who are uninsured. That number fell from 8.1 million to 7.3 million in 2008. That's the lowest mark since 1987, the first year that comparable data were collected.

Many more kids gained coverage in Medicaid and the State Children's Health Insurance Program. Medicaid's overall enrollment swelled to 42.6 million in 2008, a jump of 3 million. "As people lost jobs and their incomes fell, they became more likely to be eligible for government coverage -- children especially,’" says Custer. "That's what the Medicaid program was designed for."

The growth in Medicaid enrollment has put severe pressure on state budgets, he says.

Job-Based Health Insurance Declines

While the number of uninsured children declined, the figure for adults rose. Many older adults below age 65 - when they're eligible for Medicare - are likely to have significant health care needs, Custer says. "Older adults need health care the most."

The troubling decline in employment-based health coverage has continued. The 2008 report showed job-based coverage dropped for the eighth year in a row -- from 59.3% of Americans in 2007 to 58.5%.

"Smaller firms will find it increasingly difficult to maintain or afford coverage," says Peter Cunningham, a senior fellow at the Center for Studying Health System Change. "It's likely we'll see an even bigger drop [in job-based coverage] next year. It will reflect the higher unemployment rate in 2009."

The Census report shows about 20% of the uninsured are in households making $75,000 or more.

"Some of these individuals have health conditions that may mean insurers won't cover them," Custer says. "Some may work for small firms or be self-employed.’" And some, he added, simply may choose not to obtain coverage.

Another 20% of uninsured are not citizens, the report states, though there is no breakdown on whether they are legal or illegal immigrants.

Cunningham says the health insurance problem won't get better on its own, even when the economy improves.

The cost of health insurance and the cost of medical care, he says, are driving the increase in the uninsured.

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