The Census Bureau added some clarity Thursday to the fierce debate over government's role in health care: Without government intervention, the number of uninsured would have soared last year.
Although the 46.3 million people without health insurance in 2008 was slightly more than in 2007, private and employer-based insurance declined significantly. What made up the difference: Medicare, Medicaid and the state Children's Health Insurance Program.
The government intervention was one of several factors holding down the number of uninsured during a recession. In addition:
*The data list as uninsured only those people who didn't have insurance for the entire year. Those who lost insurance along with their jobs during the year are not counted as uninsured.
*Because unemployment worsened significantly this year -- going from 7.2% in December to 9.7% last month -- President Obama and health experts say the number of uninsured probably is much higher today.
The data and projections gave Obama something new to discuss Thursday in a pep talk to the American Nurses Association, which backs his effort to revamp health care. Obama, fresh off his speech to a joint session of Congress, said he wants a "full-court press" in the coming month.
"Since the recession intensified last September, the situation has grown worse," Obama said, referring to a Gallup survey. "Over the last 12 months, it's estimated that the ranks of the uninsured have swelled by nearly 6 million people. That's 17,000 men and women every single day."
Obama's proposal would provide subsidies to millions of the uninsured, crack down on restrictive insurance practices, mandate that individuals get coverage and large employers provide it or pay a fee, and establish a "public option" to compete with private insurance plans. It would cost about $900 billion over 10 years, to be paid for mostly with Medicare savings and a fee on the richest insurance plans.
The Census data show a steady decline in employer-provided health insurance, down from 64% in 2000 to 58.5% last year. They show the biggest annual increases in Medicaid and Medicare in more than two decades. More than one in three people with insurance, or 34%, get their coverage from the government.
The rise in government-provided insurance was caused by rising poverty numbers, the decline in private insurance and greater outreach and enrollment efforts in some states, particularly for the popular children's program. The number and percentage of children younger than 18 without insurance reached a 20-year low: 7.3 million, or 9.9%.
Ron Pollack, executive director of the health advocacy group Families USA, said that closer to 87 million people were without insurance at some point during the past two years. As the unemployment rate has risen since December, he said, the number of uninsured probably has risen as well. "The number of uninsured today is probably close to 50 million," Pollack said.
On the other hand, a study in the journal Health Affairs said the number of uninsured may be overstated because the number of Medicaid recipients usually is undercounted.
The Census data also showed:
*The uninsured rate in states varied last year from about 5.5% in Massachusetts, which passed a law in 2006 mandating insurance coverage and offering subsidies, to about 25% in Texas.
*Hispanics continued to fare the worst, but their percentage of uninsured declined to about 31%. Whites fared the best, but their uninsured rate rose to 14.5%.
*More than one in five of the uninsured were not U.S. citizens, the same as in 2007.
*Household income falls, 1A
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