Growing Numbers Of Working Adults Lack Health Insurance

by Tracy Staton

A job is no guarantee of health coverage. And in the South, there's a growing likelihood that for working adults, staying employed is less and less likely to offer access to affordable health insurance.

That's the bottom line of a new survey from the Robert Wood Johnson Foundation, which took a detailed look at the status of the uninsured in all 50 states.

Louisiana was tied for second place among states with heavy concentrations of the uninsured, with 23 percent of the working population lacking coverage. Altogether, says the Foundation, Louisiana was home to 912,000 people without insurance. (Texas was first among the worst, with 27 percent of working adults lacking coverage. Minnesota with 7 percent uninsured and Hawaii, Delaware and the District of Columbia each with about 9 percent uninsured ranked at the top of states with the best record on the issue.)

Other states in the region also posted large concentrations of uninsured workers.

o In Mississippi, an estimated 219,540 working adults went without insurance, 18.9 percent of the total.

o In Alabama, 14.8 percent of the state's working adults were uninsured; an estimated 269,826 in all.

o In Tennessee, 13.9 percent — or 362,579 — of working adults were uninsured. And that figure predates the debate over TennCare, which has been covering a large number of the state's working poor.

According to data collected by the Census Bureau, 45 million Americans lack insurance coverage — 15.6 percent of the population. And that figure marks an increase of five million from 2000.

"Too many families suffer, and too many lives are lost because our nation has not taken action to address this problem. As a nation, and as individuals, we can either let 45 million of our neighbors live without health insurance, or we can come together and do something about it," says Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.

The survey was pieced together by the State Health Access Data Assistance Center, located at the University of Minnesota, and included data collected by the Centers for Disease Control and Prevention's 2003 Behavioral Risk Factor Surveillance System Survey. All the reports focused a spotlight on the central theme of the Cover the Uninsured Week May 1 through 8.

And all the numbers paint a startling case that for tens of millions of Americans, a lack of insurance is a sure prescription for a lack of care.

"To be blunt," says former Surgeon General C. Everett Koop, "uninsured patients are more likely to die than their insured counterparts with the same diagnosis."

Uninsured adults with chronic conditions are among the hardest hit. According to the survey, about 41 percent of uninsured adults hadn't been able to see a doctor in the last year when needed. And 56 percent of the uninsured didn't have a regular doctor to call on for help. In addition:

o About half of uninsured adults with chronic conditions said they opted out of needed care or prescription drugs because they lacked insurance.

o Uninsured adults with chronic conditions were seven times as likely not to have a usual source of care than insured adults.

o One in four uninsured adults with a chronic condition said they hadn't seen a healthcare professional in the past year, compared to one in 14 of insured adults.

Altogether, 15 percent of non-elderly adults with diabetes are not covered along with 13 percent of the same group with heart disease; 18 percent with asthma; 14 percent with hypertension and 12 percent of uninsured non-elderly adults with arthritis, rheumatoid arthritis, gout, or fibromyalgia.

Hispanics fared the worst among ethnic groups, with 69.6 percent of working adults unable to call on a personal healthcare provider. For blacks it was 54.2 percent and 48.8 percent of uninsured whites.

And there are plenty of people who can sympathize all too closely with their condition. In a separate poll, about three out of every four registered voters said they were concerned by the prospect that they could lose their health insurance. And gaining access to affordable insurance ranked as the second highest priority in the poll; second to social security and Medicare and ahead of jobs and the economy.

There has been a growing concentration of reports focusing on uninsured workers. The Commonwealth Fund, for example, recently reported that the number of young workers aged 19 to 29 that lacked insurance soared from 11.2 million to 13.4 million in just three years. And roughly two thirds of young workers at that age will go without insurance at some point in those four years. The Fund suggested expanding the state's program for children's health insurance to 23.

But just how receptive the states and the federal government will be to uninsured workers is hard to say. What is certain is that in the face of soaring Medicaid bills, most states are finding ways to cut costs, rather than add new responsibilities.