GROWTH IN UNINSURED AMERICANS OUTPACING FEDERAL SPENDING ON THE HEALTH CARE SAFETY NET

1. GROWTH IN UNINSURED AMERICANS OUTPACING FEDERAL SPENDING ON THE HEALTH CARE SAFETY NET http://www.kff.org/uninsured/kcmu110405nr.cfm

2. November 2 KFF Briefing Reports profile the growing uninsured population and portray the health care safety net as increasingly straining to meet uninsured people’s needs. New analyses found that, as the number of uninsured Americans increased by 4.6 million from 2001 to 2004, federal safety net spending per uninsured person fell from $546 to $498 during the same period. After adjusting for inflation, total federal spending for care for the uninsured increased by 1.3% from 2001-2004 while the number of uninsured increased by 11.2%. These trends resulted in an 8.9% decline in spending by the federal government per uninsured person.

4. Patchwork of federal programs • The analysis of federal spending on the health care safety net, authored by Jack Hadley and colleagues at The Urban Institute, describes the patchwork of federal money dedicated to care for the uninsured. • The report documents that federal support for community health centers increased by more than 50% over the past four years, but still only accounts for less than 3% of total federal spending on the health care safety net. • The authors noted that because more than 70% of federal support for the uninsured flows through Medicare and Medicaid, which are both under budgetary pressures, “it is unlikely that future funding will be able to close the gap or make up the difference” in the increase in the uninsured and funding for their care.

5. Increase in number of uninsured • John Holahan and Allison Cook of The Urban Institute, find that all of the 6 million increase in the number of uninsured from 2000-2004 was among adults and 2/3 of the increase was among people with incomes below 200% of poverty (about $39,000 for a family of four in 2004). • Both adults and children were affected by the 4.6 percentage point drop in the share of the nonelderly with employer coverage (67.8% to 63.3%), but children were able to obtain alternative coverage through Medicaid and the State Children’s Health Insurance Program. • When examined in even greater detail, about half of the growth in the uninsured was among young adults (ages 19-34) who experienced sharp declines in employer coverage rates. 54% of the growth occurred in the Southern region of the country which experienced the greatest growth in both the general population and low-income population combined with the largest decrease in employer coverage. This contributed to the 3.2 million increase in uninsured people in the South alone.

6. Immigrants and the uninsured • A third Commission study, also by John Holahan and Allison Cook, investigated the extent to which immigrants contribute to the growth in the uninsured population. • Immigrants are disproportionately likely to be uninsured due to their employment in low-wage jobs that are less likely to offer health coverage and restrictions on their eligibility for public coverage. • However, examining the period between 1994 and 2003, the study found that apart from the brief 1998 to 2000 period--years of unusually strong economic growth and tight labor markets-- the growth in the number of uninsured has largely been among native citizens.