BMJ 2004;329:530 (4 September)

Este artigo é científico, não é político!

Figures show more Americans do not have insurance

New York Janice Hopkins Tanne

"More Americans than ever before - 45 million - lack health insurance, and more are now living in poverty, show figures from the US Census Bureau last week.

The data, which are based on a comparison between 2002 and 2003, show that for the first time since 1995 womens average income fell and also that the ratio of womens earnings to mens earnings fell.

And the number of people living below the poverty level in the United States (based on an annual income of $18 810 (£10 500; €15 600) or less for a family of four) increased from 34.6 million to 35.9 million.

The number of people with health insurance actually increased by a million, mostly because they were covered through government plans such as Medicare, for elderly people, or Medicaid and childrens health insurance programmes for poor people.

But the percentage of the population without any health insurance rose 1.4 million, from 43.6 million (15.2% of the population) in 2002 to 45 million (15.6%) in 2003. And the percentage of uninsured children remained at 11.4%, or 8.4 million children.

The Census Bureau's report used information from its Current Population Survey, which surveyed 100,000 households­, who were randomly selected and geographically distributed, between February and April each year.
Dr Karen Davis, an economist and health policy analyst who heads the non-profit Commonwealth Fund in New York, called the bureaus report "troubling". She said, "The trends are in the wrong direction . . . The number of jobs has been going up since the recession bottomed out in August 2003, but there are more uninsured: 1.4 million is a big jump from 2002 to 2003."

On the same day that the Census Bureau issued its findings the New York Times reported that small businesses that try to provide health insurance for their employees are "bearing" the brunt of the problem. (2004 August 26; sect C: 6). It cited a study by the Kaiser Family Foundation and the Health Research and Educational Trust showing that insurance premiums for companies with fewer than 200 workers grew by 15.5% in 2003, compared with 13.2% for bigger companies.

New employees may have to wait up to six months before they are eligible for company health insurance. This could explain the rise in the number of uninsured workers between the ages of 25 and 34. And although new jobs have been created, they may not have the same benefits as before.
Premiums have risen as the cost of insurance has risen, and workers are also paying more in ?co-payments,? the portion of doctors? fees and prescription charges they have to pay themselves. This is particularly hard for those who earn less than $50 000 (£27 800, ?41 300) a year.
A recent report from the Commonwealth Fund, The Affordability Crisis in US Health Care, showed that 71% of working adults in the United States found it difficult to pay medical bills. Even 41% of people with insurance had problems with medical costs".

Income, Poverty, and Health Insurance Coverage in the United States: 2003 is accessible at www.census.gov/hhes/www/income.html