The Uninsured

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• RAY SUAREZ:

  A new report finds that the problem of the uninsured is both larger and affects more of the middle-class in America than is typically discussed. Each year, the Census Bureau reports the number of people who have no health insurance over the course of an entire year. In 2002, that was more 43 million. But a new study of Census data by the private group, Families USA, shows a larger percentage of people who lack coverage at some point during a given year. The report found that nearly 82 million people lacked coverage at some point over the last two years.

  Here to help fill us in on the study and the larger issue is our health correspondent, Susan Dentzer. Well, Susan, how do we get from that often used figure of 43-plus million people that's part of the political debate over the lack of insurance in the country to that truly eye-popping 82 million number? Did Families USA measure something different, ask a different question in essence?

• SUSAN DENTZER:

  Families USA, Ray, asked a private estimating group known as the Lewin Group to go back and look at various sources of census data and basically take a look not just over a one-year period, as you said, the widely recognized statistic of almost 44 million uninsured pertains to one year. It's thought to represent people who are uninsured over one year, the previous year. They decided to look at a two-year figure basically 2002 and 2003 and to set not the standard that people had to be uninsured for that full year, but that they had to be uninsured for at least a month.

  If you look at those two factors — you're uninsured for at least a month and sometime over the course of 2002 and 2003 combined — that's what gets up to this, as you say, rather astounding figure of nearly 82 million people in America, nearly one out of three of those in America who are below the age of 65. Those 65 and over of course as we know are typically covered under Medicare.

• RAY SUAREZ:

  By widening the frame to include both 2002 and 2003, do you also capture some of the fluid nature of the uninsured population?

• SUSAN DENTZER:

  There's no question about that as well as setting the standard of one month or more. There's been longstanding debate over what these numbers really mean. And basically what is the extent and duration of the uninsurance problem in America? Is it a kind of a short-term episodic situation where people are moving in and out of jobs, moving in and out of insurance coverage, they may go through a spell of uninsurance but they will soon become covered again as they go to work for an employer who offers coverage. Is it that or is it more a case where people are without coverage for a very long period of time?

  This kind of study in effect says all of the above. All of those things are occurring. That makes it a complex problem. For example, 14 million people were found to be uninsured for the full two-year period. And if they were uninsured for the full two-year period, one can surmise they're probably going to be uninsured for longer than that. That's 5 percent essentially of the non-elderly U.S. population. So that's a significant chunk of people who were uninsured. And overall, two-thirds of this 82 million people were uninsured for six months or more.

  So again that's not necessarily a permanent spell or even a particularly long-lasting spell of uninsurance but it's still long enough that it's going to cause a lot of agony for families and one can again imagine that there are going to be preventive services that go undone, mammograms that don't get taken, maybe doctor's visits for earaches for children that don't occur during that period that that family or those individuals have gone without health insurance.

• RAY SUAREZ:

  We often associate lack of insurance with work force problems, people who have spells of unemployment, but the Families USA report found that an awful lot of the uninsured work.

• SUSAN DENTZER:

  Well, in fact, it's been known for a long time that the preponderance of those without health insurance are people in families where at least one person is either working fulltime or where there is a strong attachment to the labor force. Even if somebody is unemployed they're actively looking for work. This study does reaffirm that — that four out of five of the uninsured again are either working or looking actively for work if they're unemployed in which case they're still counted as being in the labor force. So that's been an important reiteration of earlier findings.

• RAY SUAREZ:

  And it would seem earning middle class median level income earnings as well. Not in the lowest quintile of the population, the lowest fifth of the work force.

• SUSAN DENTZER:

  Very much so. In fact another somewhat surprising finding is reaffirming the fact that many families are rather far up the income scale. Essentially nearly a quarter of the uninsured are in families or were in families in 2002 or 2003, people who had spells of uninsurance were earning between three and four times the federal poverty level. In 2003 that was for a family of four incomes between $56,000 and $75,000.

  If you look at just those earning more than $75,000, there were 14 million people in that category who were without health insurance again for some period of time. That's probably mostly explainable by people becoming unemployed, having high incomes for the year that suddenly disappeared when a job was lost but because of the extremely high cost of health insurance particularly for people who have no employer picking up some share of the tab, that becomes unaffordable and people are sometimes inclined to drop coverage.

• RAY SUAREZ:

  We also saw a very different outlook for different population groups inside the country, racial and ethnic.

• SUSAN DENTZER:

  Absolutely. In essence nearly 60 percent of Hispanics or Latinos emerge from this survey as going without health insurance again over the course of this 2002-2003 period. It continues to be true that the largest single ethnic group of those without health insurance are white; 48 percent. But your disposition or your predisposition to become uninsured is much, much higher if you're a Latino and not that much lower, in other words, still high if you're African-American. So this tends to be a problem which really for Latinos in particular are very, very at risk for.

  Interestingly enough, that tends to equate to where those elements of the population tend to be distributed. We think of Latinos as being a heavy presence in the population in the southwest. That's exactly where the heart of America's uninsurance problem is. Highest proportion of uninsured in Texas, followed by New Mexico and then California, and several other states again in the southwest or the south. That is really again the preponderance of America's health insurance problem — again another very interesting way to slice this whole issue.

• RAY SUAREZ:

  A lot of the political energy around uninsurance as an issue focus on children both at the state level and at the federal level. Yet it seems that there is still an awful lot of uninsured children for all those efforts being made at various levels of government.

• SUSAN DENTZER:

  No question about it, and at today's Families USA news conference, Families USA by the way tends to be a group that is mainly aligned with Democrats and not surprisingly today three Democratic governors were on hand at the news conference to talk about the effect in their states. What the governors said in particular was they're extremely worried about just the situation you described; children in part because of the heavy pressures on Medicaid.

  We've taken extraordinary strides in this country in the last several years to both expand Medicaid and create and expand a program called the Children's Health Insurance Program, which has indeed done a lot to reduce the ranks of uninsured children. Nonetheless, as you say, 27 million children emerged as having been uninsured at some period of time in 2002-2003. That's 37 percent of American kids going through a spell of uninsurance.

  If you put that together with another phenomenal statistic which is that basically four out of ten births in this country are now paid for by Medicaid what it means is lots of kids are being brought into the world with Medicaid paying the bill and somehow then they disappear from the protections of Medicaid and the Children's Health Insurance Program. And the governors pointed out that this is a particular issue now as states continue to dig out from under their fiscal problems, possibly face some cutbacks in Medicaid and already six states have frozen enrollment in those programs, Medicaid over the last couple of years. They're worried that that may be the shape of things to come.

• RAY SUAREZ:

  Susan Dentzer, thanks a lot.

• SUSAN DENTZER:

  Thanks, Ray.