WASHINGTON - The number of Americans who don't have health insurance rose sharply in 2002, mainly because of unemployment increases and two straight years of cuts in employer-provided health coverage.

This is no longer an issue of altruism on behalf of a discredited and disadvantaged population. It is now a concern of self-interest for middle class and working families.

Ron Pollack Families U.S.A

The number of uninsured Americans jumped by 2.4 million to 43.6 million last year, the U.S. Census Bureau reported Monday. That's 15.2 percent of the population, compared with 14.6 percent in 2001.

The increase was the steepest since the recession of the early '90s, when the percentage of uninsured also hovered around 15 percent.

The 2002 increase would have been "twice as large or larger" if Medicaid, the public health program for the poor, and the State Children's Health Insurance Program, a state-federal initiative for low-income children, hadn't picked up the slack, said Robert Greenstein, the executive director of the Center on Budget and Policy Priorities, a liberal research group in Washington. Those programs increased enrollments by a total of 4 million last year. Many states are cutting them back now because of tight budgets.

The sour news on the uninsured overshadowed the fact that in 2002 the total number of people with health care - 242.4 million - increased by 1.5 million over 2001.

The Census Bureau derives the findings from an annual survey of 78,000 households. Virtually all the survey's findings are at the 90 percent confidence level or higher.

The plight of the uninsured is one of the most crucial problems in modern medicine. People without coverage are more likely to forgo preventive care and seek treatment only when their illnesses require visits to hospital emergency rooms. By that time, their illnesses typically are more advanced, and more costly to treat.

The problem tends to be gravest for vascular diseases that have no overt symptoms in their early stages, such as hypertension, diabetes, heart attacks and stroke. In addition, cancers among the uninsured tend to be noticed at more advanced stages. Once the uninsured seek treatment, they are more likely to receive inadequate care and to die sooner, according to numerous studies.

The 2001 increases were across the board, among whites, blacks, Hispanics and all age groups, from 18 to 64.

Most experts expected higher numbers of uninsured due to the sluggish economy, job cuts and employers' growing reluctance to pay rising health-care insurance rates. But the scope and size of the increases showed the problem no longer is limited to the poor.

Last year's declines in coverage were greatest among middle-income families, the Census Bureau found. The percentage of families without coverage who earn $25,000 to $49,999 annually rose from 17.3 percent (13.5 million people) in 2001 to 19.3 percent (14.6 million people) last year.

"This is no longer an issue of altruism on behalf of a discredited and disadvantaged population. It is now a concern of self-interest for middle class and working families," said Ron Pollack, the executive director of Families U.S.A., a liberal consumer advocacy group in Washington.

People who identified themselves as Hispanic had the lowest overall rate of coverage (67.6 percent). Blacks and Asians were next, at 79.8 percent and 81.6 percent, respectively. Non-Hispanic whites had the highest rate of coverage, 89.3 percent.

The price of going uninsured can be life itself, said Dr. Elizabeth Lorde-Rollins, an obstetrician-gynecologist at the William F. Ryan Community Health Center in Manhattan. She recalled an uninsured patient who was told her Pap smear was abnormal, but waited five years to seek treatment. By then she had advanced cervical cancer. The woman worked full-time at a greenhouse, but didn't have health coverage.

"She made sure her children had coverage and dental care, but let her own health suffer because she couldn't afford the treatments. We're seeing that more and more," Lorde-Rollins said.

Uninsured families, although they often can least afford it, generally pay more out of their own pockets for medical care when they get it. They pay, on average, 88 percent of their prescription drug costs, according to a recent study by the Institute of Medicine, a unit of the National Academy of Sciences.

Hospitals that provide emergency care regardless of a patient's ability to pay for it are hit especially hard by increases in the number of uninsured patients. Many have closed or reduced services.

The Harbor-UCLA Medical Center in Los Angeles, which serves a mostly uninsured clientele, has dropped from 2,600 inpatient beds in 1995 to 1,800, for example.

"The county intends to close more beds if the court system will allow it," said Dr. Robert Hockberger, the chief of emergency medicine at the facility. "We've also cut significant amounts of staff over the last eight years."

Hockberger said that as medical bills for uninsured families accumulated, children often left school to work and support sick loved ones.

"One by one, they drop out to get jobs to pay for food, clothing and medical care as mama and grandpa who don't have insurance or regular medical care get sick. It creates a vicious cycle, and their attempts at the American dream are thwarted," Hockberger said.

The estimated percentage of uninsured people in 2002 varied widely state to state, from lows of 8 percent in Minnesota, Rhode Island, Wisconsin and Iowa to a high of 24.1 percent in Texas.

(The Census report found that the percentage of uninsured residents grew in 18 states. Those states and their percentages of uninsured residents are: Colorado, 15.3 percent; Idaho, 16.4 percent; Indiana, 12 percent; Maryland, 12 percent; Michigan, 10.4 percent; Mississippi, 15.6 percent; Missouri, 10.4 percent; Nevada, 17.5 percent; New Hampshire, 9.2 percent; New Jersey, 13.1 percent; North Carolina, 14.9 percent; Oregon, 13.3 percent; Pennsylvania, 9.7 percent; Rhode Island, 8.3 percent; Texas, 24.1 percent; Vermont, 9.6 percent; Virginia, 12 percent; and Wisconsin, 8.4 percent.

(Only New Mexico showed a decrease, to 22 percent.)

Copyright 2003 Knight-Ridder

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