More Americans Have No Health Insurance

Census Bureau Report Shows Slight Increase in Uninsured in 2008

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Sept. 10, 2009 -- The number of Americans without health insurance rose slightly to 46.3 million in 2008, as enrollment growth in safety-net programs helped counter the continued slippage in job-based coverage.

The annual Census Bureau report, released Thursday, shows that an additional 680,000 people had no health insurance last year.

But wait till the next Census report, health care analysts warn.

The data on 2009 will likely show a much bigger jump in the uninsured, when the full brunt of the recession will be documented.

"This is only the tip of the iceberg,’" says Elise Gould, director of health policy research for the Economic Policy Institute. "It's a virtual certainty that with the deepening of the recession this year, more Americans are losing health insurance.’"

The current uninsured number is likely approaching 50 million, Gould says.

Uninsured in America

The overall percentage of Americans without health coverage in 2008, 15.4%, is statistically unchanged from the year before.

"I'm a little surprised that the number of uninsured didn't climb more,"’ says Bill Custer, a health insurance expert at Georgia State University.

But Custer also notes that the Census asked people whether they had insurance coverage at any time last year. So if someone lost job-based insurance in February of last year, that person would be counted as being insured in 2008.

A fuller picture of the recession's impact on the uninsured will be seen in next year's Census report, Custer says.

The new Census report, tracking the first full year of the recession, also shows that the nation's poverty rate increased to 13.2%, up from 12.5% in 2007, and representing the highest rate since 1997. Median household income fell 3.6% to $50,303.

The 46.3 million uninsured figure is still below a high of 47 million reported in 2006.

It's unclear how the uninsured numbers will play out in the raucous debate on health care reform. Gould says the statistics show the need for change. "Americans need affordable, secure alternatives to a system wherein you lose your coverage when you lose your job. The status quo is simply not a viable solution."


President Barack Obama, who addressed a joint session of Congress on health reform Wednesday night, said Thursday of the health insurance figures, "The situation's grown worse over the last 12 months. It's estimated that the ranks of the uninsured have swelled by at least 6 million.’"

Various reform plans aim to extend coverage to most, if not all, of the uninsured. Republicans, though, have pointed out that millions without health insurance are eligible for government programs yet are not enrolled, and that millions more are in households with incomes of $75,000 or more. Many uninsured are also illegal immigrants, Sen. Orrin Hatch. R-Utah, said recently.

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.

WebMD Health News Reviewed by Louise Chang, MD on September 10, 2009



U.S. Census Bureau.

Bill Custer, associate professor, Institute of Health Administration, Georgia State University.

Peter Cunningham, senior fellow, The Center for Studying Health Insurance Change.

Elise Gould, director of health policy research, The Economic Policy Institute.

The Associated Press.


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