The Census, Uninsurance, And Health Reform

healthcaresymbol2.jpgToday’s new 2009 census numbers quantify the consequences of a downturn economy and eroding health care system. The cycle goes something like this: job loss leads to loss of employer-based coverage leads to enrollment in a public plan, an individual policy, or uninsurance. The public health infrastructure isn’t funded well enough to catch all those who need insurance and the existing individual health care market is too expensive and unregulated to offer insurance to anyone who actually needs it. Consequently, millions join the ranks of the uninsured.

In 2009, “the number of people without health insurance coverage rose from 46.3 million in 2008 to 50.7 million in 2009, while the percentage increased from 15.4 percent to 16.7 percent over the same period.” And as a growing number lost coverage, they turned to existing public programs:

– First year that total number of people with insurance decreased: The number of people with health insurance decreased from 255.1 million in 2008 to 253.6 million in 2009.

– Public coverage up, private coverage down: Between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, while the number covered by government health insurance climbed from 87.4 million to 93.2 million.

– Record numbers turn to public coverage: The percentage of people covered by private insurance (63.9 percent) is the lowest since that 1987, as is the percentage of people covered by employment-based insurance (55.8 percent). Percentage of people covered by public insurance is at its highest — 30.6 percent, 15.7 percent in Medicaid.




Despite the popular perception, health care reform will actually shore up the private insurance market. The lates CMS report estimates that “enrollment in private health insurance plans through the Affordable Care Act’s exchanges is projected to increase from an initial 15.8 million enrollees in 2014 to 30.6 million by 2019,” and approximately 15 to 16 million will find coverage through Medicaid.

Currently, public programs are open mostly to children under 18, seniors over 65, the poor or disabled. And those are groups with the steadiest access to health care, despite the economic instability. The uninsured rate rose for everyone else. Those under 65 saw their uninsurance rate increase in 2009 to 18.8% from 17.3% in 2008. The uninsured rate in 2009 for those aged 65 and older, however, hovered around hovered at around 1.8%.

It’s also worth reiterating the critical role public health plays in patching up the cracks of our health care system: these public health insurance programs provide much needed coverage for 93 million Americans. They pick-up where private insurers leave off, making insurance more affordable for low-income Americans and insuring a disproportionate percent of individuals with disabilities or severe health problems. They’re absolutely critical in our public/private hybrid health care system — could one even imagine what these numbers would look like without them?