Uninsured Rate Falls as Government Programs Enroll More


The number of Americans without health insurance coverage dropped to 45.7 million in 2007, down from 47 million in 2006, mainly because of increased enrollment in government-funded health insurance programs, according to new data from the U.S. Census Bureau.

The percentage of uninsured Americans fell from 15.8% in 2006 to 15.3% in 2007.

The Census data also showed that fewer U.S. children went without health insurance in 2007. The number of uninsured children fell from 8.7 million in 2006 (11.7%) to 8.1 million in 2007 (11%).

The new figures, which were released by the Census Bureau on Aug. 26, come from the Annual Social and Economic Supplement to the Current Population Survey.

While Census officials are still researching why the number of uninsured Americans has decreased, the data point toward increased enrollment in government-funded health insurance programs. For example, the number of Americans covered by private health insurance stayed about the same at 202 million, but the number of individuals covered by government health insurance programs rose to 83 million from 80.3 million in 2006.

There were statistically significant increases in the percentage of people covered by both Medicare and Medicaid. The number of people with Medicare coverage increased from 40.3 million (13.6%) in 2006 to 41.4 million (13.8%) in 2007, and the number enrolled in Medicaid increased from 38.3 million (12.9%) in 2006 to 39.6 million (13.2%) in 2007.

“The expansion in public coverage is really what's driving this reduction,” said Len Nichols, Ph.D., an economist and director of the health policy program at the New America Foundation, a nonpartisan public policy institute.

As the economy has weakened, more people who previously could not afford private coverage became eligible for public programs, he said. The good news is that the public programs safety net has caught these individuals, Dr. Nichols said, but the downside is that more and more people will drift into government-sponsored coverage if the government remains stalled on health care reform.

A careful analysis of the Census figures shows that the private health insurance system in the United States is “hanging on by its fingernails,” Dr. Nichols said, and is in need of reform.

There are worrisome trends in the Census data that could soon cause the number of uninsured Americans to go back up, said Mark A. Goldberg, senior vice president for policy and strategy at the National Coalition on Health Care. The organization is a nonpartisan coalition focused on achieving coverage for all Americans.

Even though the number of uninsured Americans declined in 2007, the percentage of individuals who were able to obtain either employer-based or individual coverage also dropped. If the current economic downturn continues, safety net programs like Medicaid will be vulnerable to state-level budget cuts, Mr. Goldberg said, and could be unable to keep up with demand.

The latest uninsured figures highlight the need to shore up the employer-based health insurance system, said Karen Davis, Ph.D., president of the Commonwealth Fund. Policy makers need to find ways to make coverage more affordable for employers who want to offer it to their workers and for individuals purchasing their own, she said. Leaders should consider the range of options for expanding coverage under a mixed public-private system, whether it is requiring employers to offer coverage or contribute to it, or requiring individuals to obtain coverage and offering assistance to pay for it, she said.

“The problem is real and the public wants their leaders to do something about it,” Dr. Davis said.

The private health insurance system is 'hanging on by its fingernails' and is in need of reform. DR. NICHOLS

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