Slight Drop in Uninsured Masks Deepening Problem, Doctors Say

Data released this morning by the Census Bureau showing a slight
drop in the number of Americans who lacked health insurance in 2007
masks an acute and worsening problem of access to care, a national
doctors' group said today. The figures also do not reflect the harmful
consequences of this year's economic downturn, the group said.

Census officials reported that the number of uninsured dropped from
47 million in 2006 to 45.7 million in 2007, or by half a percentage
point (from 15.8 percent to 15.3 percent)

"While any drop in the number of uninsured is welcome news, a closer
look at the Census Bureau data for 2007 provides little cause for
celebration," said Dr. Don McCanne, senior policy fellow at Physicians
for a National Health Program.

McCanne said the number of people covered by employer-sponsored
plans stayed about the same or slightly declined (0.4 percent),
continuing a long-term trend of eroding coverage from this traditional
source. While 64 percent of the population was covered by
employment-based plans in 1999, only 59.3 percent was covered in this
way in 2007.

Upon closer examination of the data, McCanne said, it is clear that
last year's gain in the number of insured people was entirely
attributable to an expansion of government programs like Medicare and
Medicaid. The number of people covered by government health insurance
programs increased by 2.7 million. Were it not for this increase, he
said, the uninsured numbers would have surpassed the 2006 figure.

"The new figure - 45.7 million uninsured - is still unacceptably
high," he said. "It's the second-highest figure since the 1960s, when
Medicare and Medicaid were enacted into law. We still have at least 8.1
million children who are uninsured, a scandalous figure."

McCanne said the Census Bureau report is silent on another problem,
which he called "the explosion in the rate of underinsurance." People
are typically defined as underinsured if they spend 10 percent or more
of their income (or 5 percent if they are low-income) on out-of-pocket
medical expenses or if they had deductibles equal to 5 percent or more
of their income.

While the number of underinsured is difficult to measure, he said,
last June the Commonwealth Fund estimated that 25 million people were
in this category in 2007, up 60 percent from 2003. Some health policy
experts estimate the number of underinsured to be 50 million.

"Not having health insurance, or having poor quality insurance that
doesn't protect you from financial hardship in the face of medical
need, is a source of mounting stress, anguish and poor medical outcomes
for people across our country," McCanne said.

He said African Americans are almost twice as likely to be uninsured
as whites, and that Hispanics are three times more likely to be
uninsured. While minorities, like whites, posted slight improvements in
coverage in 2007, "such gains are of little consolation when compared
to the enormity of these disparities," he said.

Several studies have shown that economic recessions, with their
attendant job losses, correlate with an increase in the number of
uninsured. For example, a January report by John Schmitt and Dean Baker
at the Center for Economic and Policy Research suggests that in a
mild-to-moderate recession health insurance coverage is likely to fall
1.4 percentage points, leaving an additional 4.2 million individuals
without insurance. A more severe recession would have worse
consequences.

Many economists believe a recession began in the U.S.
at the end of 2007. As a result, McCanne said, it is likely that the
Census Bureau figures present a misleading picture of the current
situation. "The continuing high profile of the health care issue in the
elections is another index of public anxiety about access to care," he
said.

The growing financial difficulties of the much-touted incremental
reforms in Massachusetts, he said, shows that its short-term gains in
reducing the number of uninsured are in jeopardy.

McCanne said fundamental health care reform is possible. "What is
really needed is a system that removes the financial burden from
patients and more effectively pools our funds into a public program
that is able to address costs more effectively by introducing greater
efficiency and value into our health care system.

"Such a system would guarantee comprehensive health care to everyone
by replacing the private insurance industry with a tax-supported
government agency or agencies that would pay all medical bills, similar
to the way Medicare operates today, but even better than Medicare," he
said. "People would have the freedom to choose their own doctors and
hospitals.

"That's a single-payer system. Such a system is embodied in H.R. 676, the U.S. National
Health Insurance Act, introduced by Rep. John Conyers (D-Mich.). It
currently has over 90 co-sponsors in Congress, more than any other
health reform proposal."

A table showing the number of uninsured by state for the years 2004-2007 is available here. Physicians for a National Health Program has physician-spokespersons in every state who are available for comment.