WASHINGTON -- A new study shows that the number of Americans lacking health insurance is rising every year and may now exceed 39 million -- a number immediately seized on by Clinton administration officials as evidence of the need for health care reform.
The number of uninsured Americans under 65 -- the age when they become eligible for federally subsidized Medicare coverage -- rose from 36.3 million in 1991 to 38.5 million last year -- an increase of 2.2 million, according to the study released yesterday by the Employee Benefit Research Institute, a respected non-partisan organization in Washington.
The percentage of non-elderly Americans without health insurance increased from 16.6 percent in 1991 to 17.4 percent in 1992.
Marylanders fared better than the nation average; 14 percent of people under 65 lacked insurance in 1992.
Most of the recent increase in the uninsured is due to cutbacks in health benefits by small businesses reacting to the rising cost of insurance, institute officials said.
Clinton administration officials, who are pushing a sweeping health reform plan that would guarantee all Americans insurance by 1998, said the study demonstrates the need for universal coverage.
They are worried that Congress may embrace a less ambitious health reform plan that does not achieve the president's goal.
"I think it just continues to show that there is a growing need for universal coverage and also that this is another clear sign we need to act on health care reform now," said Jeff Eller, a White House spokesman
Although the increase in the uninsured was particularly sharp in 1992 -- and contributed to the current political demand for health reform, institute officials suggested -- the number has been rising for years. In 1988, 15.9 percent had no coverage.
At the pace of the past few years, the number of uninsured in 1993 would exceed 39 million, but William Custer, the institute's research director, declined to speculate on what the number might be.
Institute officials said their numbers were obtained from a
Census Bureau survey in March of 150,000 Americans. The numbers represent people who lacked coverage for at least part of the year.
Typically, the uninsured make less than $20,000 a year but are not poor enough to qualify for Medicaid, the federal health program for the poor, the study shows.
Many work in small businesses that don't offer coverage, often because it is unaffordable. Rates for smaller firms are often higher than for big companies where the cost of health care is spread among a larger number of workers.
President Clinton's reform plan would force all businesses to contribute 80 percent of their workers' health insurance premiums, with employees picking up the other 20 percent. Small businesses and low-income workers would be eligible for federal subsidies under the president's proposal.
Despite the preponderance of low-income workers, the ranks of the uninsured also include middle-income people who lose their jobs and people such as Erin Good of Annapolis, a "contract" worker for the state of Maryland, who doesn't receive the same benefits as regular employees.
She has insurance now, a continuation of a policy she had with a previous employer, but it expires in February. Unless she finds a new job that provides insurance, she'll have to go without.
"I would not be able to afford" to buy insurance, said the 25-year-old marketing specialist, since coverage can cost more than $400 a month.
Like many Americans, she is finding that insurance benefits often dictate where to work. "I'd rather not leave this office because I like it here and like what I'm doing," she said. "But I'm in a bind."
A number of laid-off Westinghouse workers in Maryland have not found affordable benefits of the kind they used to have.
Richard Miner, 59, a mechanical engineer who in 1991 lost his job at the plant next to Baltimore-Washington International Airport, doesn't have insurance today.
Now a self-employed securities dealer and financial planner in Glen Burnie, he said, "I could purchase insurance if I wanted because I do sell it."
Gambles he won't need it
But given his long history of good health, he gambles that he won't need it. "If you get into something that is cataclysmic, that can wipe you out," he acknowledged. "But paying all those insurance premiums, that can take a toll."
Mr. Miner's former Westinghouse colleague, Steven Chapman of Arnold, compromised on his insurance coverage after he was NTC laid off from an administrative job in 1991.
A self-employed real estate salesman today, he decided not to buy the same kind of comprehensive policy he once had, but a policy that would protect him and his family in the event of a costly health problem.
He pays $207 a month for his policy, which requires him to pay the first $3,000 in health bills out of his pocket each year, after which the policy would pay 80 percent. So far, he hasn't had big bills.
"The only way I can justify it is I'm covered in a catastrophic situation," said Mr. Chapman, 44, who's angry at having such little insurance choice -- and such high costs.
"You're just really a slave to whatever the premium is they tell you."