Americans at Risk: One in Three Uninsured

Copies of reports for each state, in pdf format, can be found here.

Every year, the U.S. Census Bureau—in its Current Population Survey (CPS)—reports the number of people who are uninsured. This widely quoted number is intended to offer an estimate of how many people did not have any type of health insurance at any point in time during the previous calendar year. There are many people, however, who are uninsured for a portion of a year but not for the entire year. Though these individuals may suffer severe consequences to their health and their economic well-being as a result of being uninsured, they are not included in the Census Bureau’s number. In March 2009, Families USA released a new report, Americans at Risk: One in Three Uninsured, which was designed to provide a comprehensive picture of how many Americans were directly affected by the lack of health coverage in 2007-2008. That report contains national data, as well as a detailed discussion of the methodology.

The following is a spreadsheet I put together with data from each state report:

*Number & percent refer to people under the age of 65 (i.e., those not eligible for Medicare) who were uninsured for part or all of the period 2007-2008. Massachusetts is not included due to its state law mandating all citizens purchase insurance. More information on Massachusetts can be found here.

The totals are startling: 86.7 million people under the age of 65 went without health insurance for all or part of 2007-2008. This represents 33.1% of the population under the age of 65. Of this 86.7 million, 74.5% went without coverage for at least six months.

Too Great a Burden: Americans Face Rising Health Care Costs

Key findings and report can be found here. State-by-state reports can be found by scrolling down through the Families USA archives.

Long before the current economic crisis began, Americans were already straining under the burden of two related trends: shrinking coverage and rising health care costs. Over the last decade, millions of Americans have joined the ranks of the uninsured, and millions more have become underinsured as the value of their coverage has declined. At the same time, health insurance premiums and out-of-pocket costs have risen steadily, and the number of families who are facing unmanageably high health care costs has grown. Left unchecked, health care costs will keep going up, forcing more and more American families into debt—and even into bankruptcy and foreclosure. To better understand the magnitude of the health care cost crisis, Families USA commissioned The Lewin Group to analyze data from the U.S. Department of Health and Human Services and the U.S. Census Bureau that reveal how many Americans face very high health care costs. This analysis allowed us to determine how many non-elderly people are in families that will spend more than 10 percent of their pre-tax income, and more than 25 percent of their pre-tax income, on health care in 2009. Our analysis paints a stark picture: Nearly one in four Americans under the age of 65—some 64.4 million people—will spend more than 10 percent of their family income on health care in 2009. The vast majority of these people (82.6 percent) have health insurance. And 18.7 million non-elderly Americans—more than three-quarters of whom have health insurance—are in families that will spend more than 25 percent of their income on health care in 2009.

This report has findings both on people belonging to families who don't have insurance and people belonging to families that do have insurance. For each group, Families USA has compiled data on how many families are spending more than 10% of their pre-tax income on health care costs and how many families are spending more than 25% of their pre-tax income on health care costs.

While the numbers are unsurprisingly more dire for those without insurance, I'm going to include here charts regarding those who have insurance for the following reasons:

A) Because nobody wants me to include 8 bazillion charts (or, most people don't - if you want more charts follow my links).

B) It is critical that we inform people who have insurance in this country how much their situation is on thin ice, and that their out-of-pocket costs are going to continue to rise while the comprehensiveness of their coverage drops.

C) People who don't have insurance know how awful their situation is, and for the most part want a public option. Further, the key findings of this report, in addition to the findings of other reports I mention here, speak to the situation of those who are (like myself) uninsured.

This first chart has numbers on insured people in families spending more than 10% of their pre-tax income on health care in 2000 and in 2009:

This second chart has numbers on insured people in families spending more than 25% of their pre-tax income on health care in 2000 and 2009:

The reports in this group offer a wealth of information and are worth looking through. Data is provided for a variety of demographics, including families that do and do not have elderly members. No matter the demographic, the result is clear: health care costs continue to rise substantially, eating up a larger and larger portion of family income, even for those who have insurance.

One state that jumps out at me here is Montana. Only five other states are above the 30% mark for families with insurance paying more than 10% of pre-tax income for health care, and only one other state is above the 10% mark for families with insurance paying more than 25% of pre-tax income for health care. In other words: Montana is the worst off state in terms of how much of their income insured families are paying for health care. And yet Max Baucus is more interested in helping his insurance company campaign donors than the people of his state who are suffering so greatly.

The Clock Is Ticking: More Americans Losing Health Coverage

This report is only available via direct download, and

provides the first ever state-by-state data on the number of people who may lose health coverage between the beginning of 2008 and the end of 2010. Numbers are broken down per week, per month, and per year.

And yet we're told by Republicans that it's only illegal immigrants, homeless people who haven't signed up to get the assistance available to them, or people who have plenty of money around but decide they don't want to pay for insurance, who are going without insurance these days. All the rest of us who have been laid off, or who work hourly wage jobs with no benefits and who get paid just barely enough that we don't qualify for Medicaid, or who work temp jobs when we can get it, or who work part time, we're all apparently non-existent.

My own situation? I work 24 hours a week. I make just enough that I don't qualify for Medicaid. Over the last year I've been unemployed almost half the time and have had temp jobs a little more than half the time. This is all the work I've been able to find. I can't possibly afford insurance, yet I get zero help. Are Republicans willing to acknowledge that I deserve health care? Or are they supposing that I shouldn't have bothered working at all? I'm fortunate to have found the work that I've found, but I am still without insurance. What is it that they would have me do? Conjure jobs out of thin air? Would that I could! Alas, Albus Dumbledore I am not.

Costly Coverage: Premiums Outpace Paychecks

Copies of reports for each state, in pdf format, can be found here.

These reports specifically look at premiums for families, and compare the increase in those family premiums with the rise in median income. And, surprise surprise, health insurance rates have skyrocketed compared to average wage increases. On average, for the 18 states reported on so far, family premiums increased 4.4 times as much as median wages between 2000 and 2009. The following is a spreadsheet I put together to summarize the results of each report:

[ratio is how many times faster premiums have risen compared to wages]

As has been pointed out briefly, though not nearly enough, by the president, the average worker who gets health insurance through their employer might not realize that the skyrocketing costs of insurance are having an effect on them because they think, "Oh, well who cares? I'm paid for." Yet that same worker has not seen the kinds of raises that they would have otherwise earned without their employer having to continually front more and more money for health care.

Additionally, many workers have seen their co-pays and deductibles rise with the perpetual increase in premium costs, and still others have had the comprehensiveness of their plan reduced in order for their employer to be able to afford the coverage.

It should be fairly obvious that this trend is nowhere near sustainable. The American small business owner is going to find it near impossible in coming years to provide health coverage to their employees, if they already don't. And America's larger employers are not going to be as competitive in the marketplace as foreign firms because of the incredibly high cost of providing health insurance to their employees.

Beyond the already widely made arguments for a public option (choice), those who are currently covered by their employer should realize the benefits a public plan will have to their own future, and the future their children and grandchildren:

Increased wages as businesses become more profitable.

The ability of small businesses to provide for their people.

Increased competitiveness of American businesses in the global marketplace.

Consistently comprehensive coverage provided by their employer, with low deductibles and co-pays.

It is imperative to the prosperity of the American economy as a whole, and to the average American worker, that a public option (choice) be introduced to make businesses more competitive and to provide a better livelihood for employees. Without a public plan our economy is going to continue to suffer in the long-run under the weight of a gigantic health care burden.