Rising health care costs and slow growth in personal income related to the
current recession will add at least another 6.9 million nonelderly Americans
to the rolls of the uninsured by 2010, according to a study published May 28
on the Web site of the journal Health Affairs.
In the study report, researchers Todd Gilmer, Ph.D., and Richard Kronick,
Ph.D., of the University of California, San Diego, predicted that 19.2 percent
of all nonelderly Americans will be uninsured by 2010, an increase of 2
percentage points from 2007.
The researchers used a complex method that involves several data sources to
calculate an "affordability index," defined as the ratio of
per-capita health spending for insured adults to the median income among
workers. Those data sources included the National Health Accounts developed by
the Office of the Actuary at the Centers for Medicare and Medicaid Services,
the 1977 National Medical Care Expenditure Survey, the 1987 National Medical
Expenditure Survey, and the 1996 and 1999 Medical Expenditure Panel Surveys.
Their analysis also takes into account employment characteristics such as firm
size, industry, and self-employment and part-time status, as well as
demographic and socioeconomic characteristics such as age, sex, marital
status, race and ethnicity, education, and home ownership. After using their
index to derive predictions for uninsurance rates among workers, Gilmer and
Kronick used the historical relationship between coverage rates for workers
and for all nonelderly adults to generate predicted uninsurance rates for all
They estimate that the number of uninsured Americans will reach 52 million
in 2010. Among workers not covered by a dependent's plan or by a public
program, the fraction that is uninsured is expected to increase sharply,
reaching 26.4 percent in 2010.
Moreover, Gilmer and Kronick acknowledged that their model cannot
completely account for uninsurance that will arise from job losses during the
"Our model focuses on forecasting the rate of uninsurance among
workers," they write. "It does not directly take unemployment into
account. During recessions we would expect the number of uninsured people to
increase by more than projected by the model, because some of the newly
unemployed will lose coverage when they lose their jobs."
They cited researchers at Kaiser Family Foundation who have estimated that
each 1 percent increase in unemployment leads to a 0.59 percent increase in
the percentage uninsured among nonelderly adults. If unemployment were to
increase to 10 percent, the number of uninsured people would increase by close
to 6 million in the absence of policy change.
"Some of this projected increase would be in addition to our
projected increase of 6.9 million, which will occur primarily as a result of
the increasing unaffordability of health care for adults who continue
working," Gilmer and Kronick wrote.
They noted that the American Recovery and Reinvestment Act of 2009 may
somewhat attenuate the effects of increasing unemployment on the number of
uninsured people and that extension and expansion of the State Children's
Health Insurance Program is expected to reduce the number of uninsured
"Given major uncertainties about the depth and length of the
recession, about federal and state policy responses, and about the effect of
any public policy response, it would be foolish to attempt to offer precise
forecasts of the number of uninsured Americans," the researchers
observed. "These caveats notwithstanding, our work demonstrates that if
personal income grows as slowly as projected... and health care costs grow at
the rate projected by CMS, then the number of uninsured people is likely to
grow by at least 6.9 million during 2008-10."
Gilmer is an associate professor in the Department of Family and Preventive
Medicine at the University of California at San Diego, and Kronick is a
professor in that department.
"Hard Times and Health Insurance: How Many Americans Will be
Uninsured in 2010" is posted at<http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w573>.▪