October
2003
Making
Sense of the Stats: Number of U.S. Uninsured Rises to 43.6
Million
By Kate Randall
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A key barometer of the well-being of a society is its
ability to provide for the health of its citizens. New figures on the
numbers of uninsured Americans show that the U.S. is failing miserably.
In a country where the right to universal health care does not exist,
one in six men, women and children had no health coverage last year.
A September 29 report from the U.S. Census Bureau found that a total
of 43.6 million Americans—a shocking 15.2 percent of the population—had
no medical insurance in 2002, an increase of 2.4 million from the year
before. The report follows on the heels of a September 26 Census Bureau
report showing that the ranks of Americans living in poverty rose by
1.7 million in 2002, to 34.6 million people.
Every region of the country was affected by this healthcare crisis,
with the South having the highest percentage of uninsured—17.5
percent—and the Midwest the lowest, with 11.7 percent. Minnesota’s
eight percent was the lowest level of uninsured, while Texas had the
highest, 24.1 percent.
About 8.5 million children—or 11.6 percent of those under age
18—are uninsured, accounting for about one fifth of the total.
When a child’s parent loses insurance, he or she does so as well
unless the child can qualify for Medicaid, which provides limited insurance
for the poor. Federal budget cuts, however, have affected Medicaid benefits,
which are administered through the states. Genevieve M. Kenney, an economist
at the Urban Institute in Washington, D.C., told the New York Times,
“Many states, in the midst of a fiscal crisis, have reduced efforts
to locate and enroll children eligible for Medicaid.”
Despite the Medicaid program, more than 10 million people living below
the official poverty line had no health insurance last year, accounting
for about one quarter of the total number of uninsured. Half of those
with full-time jobs, but whose incomes place them below the poverty
level, were uninsured.
And as more and more adults and children lose medical coverage, they
find fewer “safety net” alternatives to catch them. In Texas,
for example, where close to a quarter of residents have no health insurance,
state authorities have cut back on Medicaid and the Children’s
Health Insurance Program (CHIP) this year.
The numbers of African Americans and non-Hispanic whites without insurance
rose last year to 20.2 percent and 10.7 percent, respectively. While
the figure for Hispanics was unchanged from the previous year, it remained
alarmingly high at 32.4 percent.
About one third of the foreign-born population in the U.S. has no medical
insurance. Of the 20.6 million non-citizens, 8.9 million were uninsured—or
about 43 percent; 17.5 percent of naturalized citizens lack coverage.
The jump in the loss of coverage is mainly attributable to job cuts,
scaled-back benefits provided by employers, and huge increases in premiums
charged by insurance companies. Because people must rely on employer-sponsored
health insurance—or purchase it privately at exorbitant costs—the
loss of a job often means not only lost income but lost medical coverage
as well. At least 11 million U.S. workers remain jobless, the highest
figure in a decade, and 3.3 million jobs have been lost in the private
sector since the beginning of the recession in March 2001.
However, being employed does not necessarily translate into having
health insurance. The proportion of employees covered by health insurance
also
dropped to 61.3 percent in 2002, from 63.6 percent in 2000. Last year,
897,000 full-time workers became uninsured, rising to a new high of
19.9 million full-time workers—45 percent of all those without
health insurance.
Middle-income households—those with annual incomes of $25,000
to $75,000—saw the largest increase in lack of health coverage.
Among these households, where at least one family member is working,
the number of uninsured rose by 1.4 million, to 21.5 million, with
the
sharpest increase among those families earning $25,000 to $50,000.
Fees charged by private healthcare companies have spiraled out of control
in recent years, with healthcare costs rising by 14 percent in the past
year alone, causing businesses to either eliminate health insurance
plans for workers or decrease coverage. Small and medium-sized businesses
are paring down health insurance for employees, charging higher premiums
and requiring workers to pay larger co-payments for prescription drugs,
office visits, and hospital and other costs.
At companies with fewer than 25 employees, only 30.8 percent of workers
had health coverage in 2002. At companies with 25 to 99 employees, coverage
also dropped, from 56.8 percent in 2001 to 54.4 in 2002. Coverage for
workers at companies with more than 1,000 employees also declined by
about a percentage point to 68.7 percent.
While smaller businesses struggle with soaring costs, large corporations
are increasingly exploiting the healthcare crisis with the aim of reaping
higher profits by slashing benefits for their workforces. Case in point:
Wal-Mart Stores, the nation’s biggest private employer with 1.16
million workers, utilizes a team of six people to search each state
for the lowest-cost networks of doctors and hospitals. It then offers
the most cut-rate level of medical insurance to its employees.
The retail giant requires new workers to wait six months to sign up
for its health care benefits plan and provides no coverage for retirees.
Some services are simply not covered: flu shots, eye exams, child vaccinations,
chiropractic services, among others. Deductibles—the amount the
patient must pay before coverage kicks in—run as high as $1,000.
In many cases, workers are not covered for pre-existing conditions
for
the first year of employment.
The Wall Street Journal cites the case of Larry Allen, 47, and his wife
Jacque, who were hired at a Las Vegas Wal-Mart store last year. They
each earned $8 an hour as produce clerks and chose to forgo coverage,
which averages $13 every two weeks and carries a $1,000 deductible.
However, Allen suffered a heart attack soon after he began working and
ran up $31,000 in medical bills and is constantly hounded by collection
agencies.
By contrast, five members of the Walton family, which owns Wal-Mart,
were recently cited in the top 10 of the Forbes list of the 400 richest
Americans, with fortunes of more than $20 billion each. The case indicates
the plight faced by the 43 million in the U.S. with no health coverage
and the millions more with inadequate benefits. In increasing numbers,
working people and their families are forced to choose between the
necessities
of life—food, housing utilities, transportation—and medical
care.
Working and poor Americans can expect little relief from healthcare
costs from the Bush administration or the Democrats and Republicans
in Congress. The House of Representatives approved a $368 billion war
budget for the Pentagon in late September, but Congress has yet to pass
any reform to the Medicare program to provide even the most minimal
prescription drug benefits for seniors.
Congress has also consistently blocked passage of any kind of universal
health plan, but pushed through a Bush-sponsored tax cut earlier this
year, giving every U.S. millionaire a tax cut averaging $93,500.
The latest figures on the growth of the uninsured are an indictment
of a system that is witnessing an ever-widening gap between the super-wealthy
and the mass of working people struggling to meet basic, everyday needs.
Kate Randall is a frequent contributor to the World Socialist Web Site.
This is an edited version of an October 3, 2003 article originally published
on the World Socialist Web Site, www.wsws.org. Reprinted with kind permission.
