Kaiser Commission study of uninsured shows dismal results

Kaiser Commission study on uninsuredUCLA's Center for Health Policy Research surprised everyone when they reported on March 16 that nearly one in four Californians, or 8 million, lacked health insurance during 2008 and 2009. That represents an increase of nearly 2 million in just one year because of the deep recession and mass layoffs.

But California isn't alone in those dismal statistics. Based on data from The Kaiser Commission on Medicaid and the Uninsured, 19 states reported uninsured rates among non-elderly adults above 20%, and four states -- Florida (26%), Louisiana (26.5%), New Mexico (30.5%) and Texas (31.5%) -- reported results above California's 25%. The Kaiser study is based on 2007-2008 data. The 2008-2009 data won't be available until October 2010. So with the deep recession and mass layoffs, we can expect these numbers to be much higher.Kaiser estimates that nationwide, the number of non-elderly uninsured Americans rose to 45.6 million in 2008, with 75% of these people going without health insurance for more than one year. In fact, 56% have gone without health insurance for more than three years.

Since health insurance is primarily obtained as an employment benefit, health coverage is disrupted when people change or lose their jobs. Only 5% of people younger than 65 get private policies they purchase directly in the non-group market. These non-group policies are usually more expensive and less comprehensive than group coverage. Even qualifying for this coverage can be difficult, especially for those who are older or have had health problems. Even if they can get coverage, their premiums will be high or their policy will exclude specific conditions.

Yet, even though people depend on their employer for health insurance, only 60% of firms offered coverage to their employees in 2009, Kaiser found. Even within those firms that offered health insurance, only 79% of their employees qualified for coverage. That's because in most companies, part-time workers don't qualify for the benefit. Also, some employees who do qualify can't afford the employee share of the premium.

The Kaiser study found that "barriers the uninsured face in getting the care that they need means they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented and are more likely to die in the hospital than those with insurance."

So who are the uninsured?

Eight in 10 uninsured come from working families. About two-thirds are individuals and families who are poor (incomes less than the federal poverty level, which was $22,025 for a family of four in 2008) or near poor (with incomes between one and two times the poverty level). Most of the non-elderly uninsured do not have access or cannot afford private insurance unless they qualify for Medicaid. Medicaid is available to children of the poor, their parents, pregnant women and individuals with disabilities. Most childless non-elderly adults do not qualify for Medicaid.

Adults are more likely to be uninsured than children, Kaiser found. "Adults make up 70% of the non-elderly population, but more than 80% of the uninsured," according to Kaiser's study.

Young adults have the highest uninsured rate -- 30% -- for any group. That's because the median income for uninsured young adults in 2008 was $15,000, so they were less likely to be able to afford insurance.

The uninsured also tend to have less education. About 62% of the non-elderly uninsured adults have no education beyond high school, so they can't get higher-skilled jobs that are more likely to provide insurance.

Minorities are more likely to be uninsured than whites, Kaiser also found. About one third of Hispanics and 21% of African-Americans are uninsured, while just 13% of whites are uninsured.

Most of the uninsured -- 80% -- are native or naturalized U.S. citizens. Kaiser found, "Although non-citizens (legal and documented) are about three times more likely to be uninsured than citizens, they are not the primary cause of the uninsured problem." Non-citizens are less likely to have employer coverage because they are in low wage jobs without benefits. Federal law bars undocumented immigrants from being enrolled in Medicaid and other coverage programs for children.

You can find out more about the status of health care in your state and how health care reform could improve your state's health insurance coverage at Families USA.

Lita Epstein has written more than 25 books including The Complete Idiot's Guide to Social Security and Medicare and The Pocket's Guide to Medicare Part D.

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