The New Health Dialogue

Fifty-two million—and rising? Is that the real count of the uninsured in the United States in this job-killing recession? It's the latest estimate from the North Carolina Institute of Medicine. And 52 million was the number for January, and unemployment rhas risen since then, hitting 8.5 percent in March. (April numbers are due out in a few days.)

The official US census figures are 46 million uninsured, but there's always a lag (it takes a long time to count 46 million people, even longer to count 52).

The North Carolina report was brought to our attention this week by the Center for American Progress, which looked at the uninsured in each state. As we know (even if there are wide misperceptions about this among the public) most uninsured people are not unemployed. They are the working poor or dependents of the working poor -- although nowadays of course more of them are losing their health coverage as they lose their job.

CAP's state by state data shows that in every state, the majority of uninsured adults are employed. In several states, including Maine, Montana, and Kansas, more than two-thirds are employed.

CAP reminds us that the status quo isn't working. The employer-sponsored insurance system still covers millions of people at big businesses, but those who are self employed, who work in service industries, and in small businesses are less and less likely to get health insurance on the job—or to be able to afford their share of the costs if it is offered. Without reform, the strains will keep growing in a time of deep recession and rapidly escalating health care costs.

In a separate report mapping uninsurance rates in the states, CAP found an overall 13-percent jump since 2007,the largest two-year leap since the last effort at national health reform in 1994. As the CAP report says:

What's more, these numbers are undoubtedly worse today due to deteriorated economic conditions and rising national and state unemployment rates since January.

It's important to point out that the national average increase obscures the unprecedented increase that some states have seen over the last two years, including a 22-percent increase in North Carolina, and Indiana, and a 21-percent increase in Nevada. Approximately 890,000 more people are uninsured in California, 551,000 more people are uninsured in Texas, and 506,000 more people are uninsured in Florida than in 2007.

Kaiser Family Foundation calculates that every one percent increase in unemployment leads to an additional 1.1 million uninsured and another 1 million added to the Medicaid and SCHIP ranks (assuming eligibility doesn't change). The recession cuts deeper than that, though, because many businesses that offer insurance to employees are cutting back or eliminating the benefit. As CAP reports, the percentage of Americans who receive their insurance through an employer has declined from 67 to 63 percent in a decade. Employers will probably continue to cut insurance benefits (and retirement contributions) as the recession wears on. We may not have even seen the worst yet; most employers have year-long contracts with health plans, and we may see more of them letting coverage lapse as they try to protect what they can of their bottom line.