Despite a strong economy, the number of people without health insurance has grown substantially, nationally and in Maryland, since 1989, according to a study released yesterday and published in the American Journal of Public Health.
Nationally, 16.1 percent of Americans were uninsured in 1997 (about 43.4 million), compared to 13.6 percent (about 35 million) in 1989, according to the study, which was based on data from the Current Population Survey conducted by the U.S. Census Bureau.
In Maryland, the proportion of the population without insurance rose to 13.4 percent (about 677,000) in 1997 from 10.2 percent (about 467,000) in 1989 -- meaning more than 200,000 additional people lack coverage.
While the Census Bureau reports the numbers each year, changes from year to year are small, so the study was designed to track and highlight trends over an extended period, said Dr. David U. Himmelstein, an associate professor of medicine at Harvard University who was one of the authors.
"What's clear is that there is a long-term, steady and quite striking increase in the number of uninsured," Himmelstein said.
Although estimates are less precise before 1989, he said, it appears that the number of uninsured is about what it was 35 years ago, when the Medicare and Medicaid programs were launched to cover the elderly and the poor.
Himmelstein and one of his co-authors, Dr. Steffie Woolhandler, are also co-founders of Physicians for a National Health Program (PNHP), a group that favors what he called a "single-payer, Canadian-style national health system." The study was part of their academic work, not a PNHP project, but the organization has been publicizing the results.
Dr. John Littlefield, a retired professor of pediatrics at Johns Hopkins, and a local spokesman for PNHP, said the study "adds fuel to the fire," demonstrating "a lack of access to health care that is appalling for a country this well off."
The other authors of the study are Dr. Olveen Carrasquillo, who did the research at Harvard but is now at Columbia University, and Dr. David H. Bor, also at Harvard.
The journal article attributes the decline in coverage to decreasing union membership, increasing use of part-time workers and the shift of jobs from manufacturing to service industries.
Also, the study notes, as premiums rise, much of the growth in uninsured seems to come from workers who can't afford health insurance, even though their employer offers it.
Himmelstein said the survey data does not provide enough information to measure how much of the growth of the uninsured can be attributed to each of the causes.
"Incremental reforms," such as the Health Insurance and Portability Act of 1996, have little impact, the study found. "Relying on employer-based health insurance means we will never have universal coverage," Himmelstein said.
Pub Date: 12/31/98