Census Bureau: More Uninsured in 2002

Published November 1, 2003

On October 2, the U.S. Census Bureau reported 43.6 million people in the U.S. were uninsured in 2002, an increase of 2.4 million over 2001 figures. The 6 percent jump was attributed primarily to a sluggish economy, which caused increased unemployment and loss of employer-provided insurance coverage.

As have past reports, the new Census Bureau analysis finds uninsurance tends to be a short-term problem: “Spells without health insurance … tend to be short in duration–about three-quarters (74.7 percent) were over within 1 year.” Between 1996 and 1999, the most recent data available, 44 percent of the spells of uninsurance lasted between two and four months.

The Census Bureau counts as uninsured employees who lost their employer-provided coverage and chose not to exercise continuing health insurance coverage options available to them under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

The number and percentage of children without insurance did not change between 2001 and 2002, but among most other population categories the rate of uninsurance increased. Most dramatically, 43.3 percent of legal and undocumented immigrants were uninsured in 2002.

Questionable Data

Robert Mills, a Census Bureau analyst, pointed to a decline in workplace-based coverage as the main reason for the increase in uninsured. In 2002, 61.3 percent of U.S. residents were covered under an employment-based insurance policy, down from 62.6 percent in 2001.

Rep. Pete Stark (D-California), a senior legislator on the Joint Economic Committee, blamed the health insurance losses on the “Bush jobless recovery.” But there is a growing debate over whether Census Bureau and Department of Labor figures accurately capture what’s happening in the labor market, the major source of health insurance.

The Department of Labor’s monthly survey of 60,000 households shows 1.4 million new jobs have been created in the U.S. economy since November 2001. Its payroll survey of 400,000 businesses, however, reports 1.1 million lost jobs.

“We know the payroll survey is missing some things for sure, like a trend in self-employment,” says John Ryding, chief market analyst at the financial company Bear Stearns.

Further weakening the Census Bureau reports is evidence respondents to surveys about insurance coverage do not count government-provided health plans as insurance. The perception is understandable: Persons covered by such insurance pay no premiums, make little or no co-payments for care, and receive no evidence of having an insurance policy.

Moreover, some people counted among the uninsured are in fact eligible for insurance, like Medicaid and the State Children’s Health Insurance Programs, but have not applied. Some policymakers believe they should be regarded as insured, because they can apply when they need the insurance and can receive retroactive coverage for their expenses. Others believe such people are properly regarded as uninsured.

Tax Credits and AHPs

Claire Buchan, a spokeswoman for the Bush administration, told reporters “the President is committed to getting the economy growing faster so the number of unemployed and uninsured Americans will go down.” Bush’s 2004 budget requests $89 billion in health care tax credits to make insurance more affordable for those who do not have employer-provided coverage.

Senator Jim Talent (R-Missouri) said he hoped the Census Bureau report would renew interest in a bill that allows small businesses to band together through national trade association health plans–AHPs–for the purpose of offering insurance to employees. The bill has passed the House but is stalled in the Senate. “Most of these people are working people, and they’re working for small businesses,” said Talent. According to Department of Labor estimates, six in 10 of the nation’s uninsured work for small businesses or depend on someone who does.

Conrad F. Meier is managing editor of Health Care News. His email address is [email protected].

For more information …

about the Census Bureau’s new report is available on the Internet at http://www.census.gov/hhes/www/hlthin02.html. The full text of the 24-page report, Health Insurance Coverage in the United States: 2002, is also available through PolicyBot, The Heartland Institute’s free online research database. Point your Web browser to http://www.heartland.org, click on the PolicyBot icon, and search for document #13142.