Last week the Kaiser Commission on Medicaid and the Uninsured issued new report giving a grim assessment of the toll the recession and high unemployment has taken on the nation's workforce: the number of uninsured rose to 50.0 million in 2009, an increase of 4.3 million. There are now nearly as many uninsured non-elderly people as those receiving Medicaid or other public insurance (such as CHIP, the children's insurance program, Medicare and military/veterans coverage).

From the issue brief [pdf]:

The gaps in our health care system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest income face the greatest risk of being uninsured. Despite strong ties to the workforce—more than three-quarters of the uninsured come from working families—four in ten of the uninsured are individuals and families who are poor (incomes less than the federal poverty level or $22,050 for a family of four in 2009). Not having health insurance makes a difference in people’s access to needed medical care and their financial security. The 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. The financial impact can also be severe. Uninsured families already struggle financially to meet basic needs, and medical bills, even for minor problems, can quickly lead to medical debt.

HuffPo provides the personal story of one of the far too many individuals trapped in this cycle. Ironically, before being laid off Francis Campos-Dunn's job had been in a California hospital, helping patients work through insurance problems. Now unemployed, Campos-Dunn has been trying to fight that battle for herself.

Back when she was still working, Campos-Dunn, 42, earned $4,000 a month, enough to make her co-payments for regular medical care. These days, she depends on $300 a month contributions from her 16-year-old son--money he earns at a part-time job--just to pay to the rent. When a recent seizure left her with two broken teeth, she skipped the required treatment and opted to have the teeth pulled instead, because she lacked the funds--a choice that would have previously seemed unthinkable.... "I never thought I'd be in this position," she said. "I used to help families get on insurance. I used to hear all these problems. I used to think anything was possible to try to figure out a way around it so they could get health insurance. Now I have no health insurance." With her medical condition continuing to require care, her battle to keep up has worn her down past the point where she can even muster the effort to continue fighting. "It got up to a point where I didn't even try to deal with them anymore," she said. "If I ended up in the hospital I'd just pay the bill." She now owes Kaiser over $55,000, she says. She owes the San Mateo County Hospital--her old employer-- over $22,000.

Campos-Dunn makes $32 too much to qualify for Medi-Cal. She has medical conditions that require treatment, so she cannot do what about a quarter of the uninsured do, according to the report: forgo care at all because of the cost. That includes not getting the basic preventive care that could help avoid bankrupting medical conditions down the road, and all too often, early and preventible death. So she's done what too many with serious medical conditions and no insurance have to do--go deeply in debt.

While high levels of unemployment have increased the number of uninsured, still more than three-quarters of the uninsured are in working families, 61% in a family with a full-time worker, and 16% in a family with a part-time worker. Many part-time workers don't have the option of enrolling in employer-based insurance, and for too many workers, that insurance is still too expensive. " The average annual total cost of employer-sponsored family coverage is $13,770 in 2010, and the share of the premium paid by workers increased to 30% this year."

There's good news on the horizon, but unfortunately it's still three years away. The Affordable Care Act will help ameliorate many of these problems in 2014, by expanding Medicaid coverage to 138% of poverty, and by requiring insurers to cover people with pre-existing conditions. But it won't cover all of the uninsured. By 2019, when it will have been fully implemented, it will extend coverage to 32 million--significant and important, but still leaving too many uninsured.

And what's the first thing the House GOP intends to do? Hold a vote on repealing the Affordable Care Act, because 50 million uninsured Americans isn't a crisis as far as they're concerned. The fact that ACORN ever existed, even though it is now defunct, now that's a crisis.