title: The vanishing health care safety net: new data on uninsured Americans.
abstract: New data obtained from the Census Bureau shows that the number of Americans without any health insurance increased by 1.3 million between 1989 and 1990, bringing the total number of uninsured to 34.7 million, more than at any time since the passage of Medicare and Medicaid 25 years ago. This increase coincided with a 10.5 percent increase in health spending, the second largest in the past three decades. The number of people covered by Medicaid grew by 3.1 million, due to a one-time expansion of eligibility mandated by Congress, but this was more than counter-balanced by a population growth of 3 million and a decrease of 1.3 million in people covered by private insurance. Had Medicaid not been expanded, the number of uninsured would have increased by 4.4 million. The increase in the uninsured affected virtually all parts of the nation. Seven states had increases of more than 100,000 persons each. Only Texas experienced a decrease of that magnitude, but still had the second highest rate of uninsurance of any state. Of the 1.3 million additional uninsured in 1990, 77 percent were male, 32 percent had family incomes in excess of $50,000 per year, and 74 percent had annual family incomes above $25,000. Fewer than 9 percent had incomes below the poverty line. The numbers of uninsured children and senior citizens fell slightly (but not significantly), while the number of uninsured working-age adults rose by 1.4 million. The number of uninsured workers in each of four of 20 major industry groups increased by more than 100,000 in 1990. None of the industry groups showed a significant decline in the number of uninsured. Among professionals, there were substantial numbers of uninsured doctors, engineers, teachers, college professors, clergy, and others, but all legislators and judges were insured. The data presented here largely predate the recession and understate current problems. In 1991 the number of uninsured will likely reach nearly 40 million. Also, these estimates are based on the number of people uninsured at a single time during 1990; a far higher number were temporarily uninsured at some point during the year. Moreover the Census Bureau survey ignores the problem of the underinsurance of at least 50 million insured Americans. Patchwork public programs are grossly inadequate to plug the holes. A national health program covering all Americans could assure access to care and contain costs.
authors.affiliation: Center for National Health Program Studies, Harvard Medical School, Cambridge Hospital, MA 02139.
authors.forename: D U
authors.initials: DU
authors.lastname: Himmelstein
authors.forename: S
authors.initials: S
authors.lastname: Woolhandler
authors.forename: S M
authors.initials: SM
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D003710:Demography; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007221:Industry / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data / Q000639:trends; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009790:Occupations; D011203:Poverty / Q000706:statistics & numerical data; D044469:Racial Groups; D014481:United States