The number of Americans living without health insurance dropped by 1.7 million in 1999, the first decline since the government began gathering the data in 1987.
The turnaround was driven mostly by an increase in the number of workers receiving health care coverage through their employers, according to the U.S. Census Bureau report, which was scheduled to be released today.
In Maryland, the ranks of the uninsured appeared to drop in 1999 after a sharp increase in 1998. But both changes were seen as statistically insignificant - the result of volatility introduced by a small survey sample in the state.
A more reliable three-year average shows about 13.9 percent of the Maryland's population was uninsured at the end of the decade.
That's still better than the national rate, which fell from 16.3 percent in 1998 to 15.5 percent last year, the Census Bureau said.
The national gains are "clearly a good thing," said Baltimore City Health Commissioner Peter L. Beilenson. He credited lower unemployment in recent years and the Children's Health Insurance Program (CHIPS), which in 1998 began expanding Medicaid benefits to include children of the working poor.
"But there are still 42 million Americans uninsured, and probably an equal number who are underinsured," he said. "That is still not acceptable in a country as incredibly wealthy as we are."
The report comes from the Census Bureau's March 2000 Current Population Survey (CPS), a sampling of 50,000 households across the nation. It is not related to the 2000 Census.
The reported gains extended to both genders, all racial and ethnic groups, all income levels below $50,000 a year, and all age groups except those over 65.
The percentage of Maryland residents that reported having no health insurance has moved sharply up and down during the past five years.
It struck a low of 11.4 percent in 1996, and a high of 16.6 percent in 1998. Last year, it fell again, to 11.8 percent.
When measured as a moving average of two years of data, however, the overall decline was slight, and not statistically significant, the report said.
"You have to take a lot of the CPS data with a grain of salt," said John M. Colmers, executive director of the Maryland Health Care Commission.
"We didn't get excited about the [Maryland] numbers going up last year, and we won't get overly excited about the numbers going down this year," Colmers said.
The state Health Care Commission is planning to conduct its own survey, using a much larger sample of Marylanders, in the spring.
Even so, the decline in the two-year averages for Maryland was encouraging to the commission's chairman, Dr. Donald E. Wilson, dean of the University of Maryland School of Medicine.
"I would suggest it represents a real drop, probably related to higher employment. More people can afford to buy [insurance]," Wilson said.
"Some of it may be related to some of the programs introduced in the last year or two designed to insure more children," he said.
Colmers said CHIPS had enrolled 58,000 Maryland children by last year. The number is now up to 76,000.
Eligibility changes that take effect next summer are expected to add another 19,000.
Nationally, the number of children younger than 18 who were uninsured in 1999 dropped from 11.1 million (15.4 percent) in 1998 to 10 million (13.9 percent).
As encouraging as the turnaround may be, Beilenson said, there are still serious problems for employees facing steep and perhaps unaffordable increases in their insurance premiums.
"And all of this is still really contingent on the incredible economic boom we've been in for the last decade," he said. "Should the economy turn, there could be significant trouble."
Staff writer M. William Salganik contributed to this article.