Thanks mostly to expanded government health coverage for children, the number of people without health insurance fell in 2007 for the first time since President Bush took office, the U.S. Census Bureau said Tuesday.
In all, the number of people without health insurance dropped last year to 45.7 million, from 47 million in 2006, according to the bureau's annual report on income, poverty and health insurance. That's a drop to 15.3% of Americans from 15.8%.
Some healthcare experts had expected the number of uninsured to increase as the long-term erosion of private, employment-based coverage continued. Instead, the figures showed a shift toward government coverage that added fuel to the debate over how to best expand access to healthcare.
"This is good news and is entirely attributable to the availability of government programs like Medicaid and the State Children's Health Insurance Program [SCHIP]," said Lynn Blewett, a health services analyst with the State Health Access Data Assistance Center at the University of Minnesota. "Programs like SCHIP and Medicaid are lifelines for providing Americans with the healthcare they need, especially during times when the economy is soft and more people feel vulnerable to losing employer-sponsored health insurance."
Overall, the number of people covered by government programs rose to 83 million in 2007, up from 80.3 million in 2006. The number of people on Medicaid, the government health insurance program for low-income residents, increased to 39.6 million from 38.3 million. And the number of children without insurance dropped to 8.1 million from 8.7 million as those with public insurance rose by almost 1 million to 23 million.
By contrast, the rate of private health insurance coverage slid to 67.5% of U.S. residents in 2007, down from 67.9% a year earlier. The total number of people with private coverage was statistically unchanged at 202 million. The employment-based insurance rate fell to 59.3% from 59.7%, but the number of people covered by such plans was statistically steady at 177.4 million.
The figures are based on data collected in 2007 and are being overshadowed by a projected decline in public coverage for children as households, employers and government agencies tighten their belts.
In California alone, an estimated 19,000 children could lose coverage because of a recent decision to increase premiums for Health Families, the state version of SCHIP, by $2 to $3 per child. An additional 196,000 children are expected to be dropped from Medi-Cal, the state version of Medicaid, over two years because of new administrative procedures.
Advocates for the uninsured said the figures underscored the need to shore up public insurance programs.
"While this decline is a temporary victory for kids, we fear next year's data will paint a worse picture for America's children than ever before, as the effects of a sluggish economy will be coupled with the inability of Congress to pass renewal of the State Children's Health Insurance Program over President Bush's two vetoes," said Bruce Lesley, president of First Focus, a children's advocacy group.
Kevin Hayden, who oversees government contracting for WellPoint Inc., the nation's largest private health insurance company with 35 million enrollees, said he didn't consider the shift toward government coverage as a mark against the private industry, but rather as "an opportunity for the private sector and the government to work together."
He said WellPoint administered government insurance programs, such as Medicaid, in several states, and he saw an expansion of public coverage as a good option for people who didn't have access to employer-sponsored coverage and couldn't afford or qualify for coverage on their own.
The "modest decline" in the uninsured did not "reduce the urgency of the crisis," said Karen Ignagni, president of the trade group America's Health Insurance Plans. She noted that the private health insurance industry had made a series of proposals over the last two years aimed at covering the uninsured, improving quality and containing costs. In fact, the industry has proposed further expanding government coverage for low-income and chronically ill residents.
Ron Pollock, president of advocacy group Families USA, said the figures showed the toll that expensive insurance premiums were taking on private coverage, which remains the primary entree to healthcare for most Americans.
"Healthcare premiums have been rising much quicker than paychecks," Pollock said. "So a lot of businesses across the country are feeling they cannot sustain the healthcare coverage they used to provide for their workers, or they are requiring workers to pay more in premiums and deductibles. And, as a result, many of the workers can no longer afford coverage."
Individuals who don't have health coverage through their jobs also are facing rising premiums, Pollock said, "and more people are priced out of the healthcare they used to take for granted."
Cherry-picking also "continues to be a big problem" in this market, he said, referring to a practice by which insurers in California and most states can exclude consumers with pre-existing medical conditions.
The rate of people buying private coverage on their own declined to 8.9% from 9.1%.