Embargoed Until:
May 28, 2009
12:01 a.m. Eastern Time



Christopher Fleming

At Least 7 Million More Americans Projected To Become Uninsured By 2010

Without Action By Congress, Increase In Uninsurance Rate May Well Be Even Higher Because Of Job Losses, Say Researchers

Bethesda, MD -- Absent policy changes, rising health care costs and sluggish growth in personal incomes will add at least 6.9 million nonelderly Americans to the ranks of the uninsured by 2010, a study published today on the Health Affairs Web site projects. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w573

In 2010, 19.2 percent of all nonelderly Americans are likely to be uninsured -- an increase of 2.0 percentage points from 2007, say Todd Gilmer and Richard Kronick of the University of California, San Diego (UCSD). They estimate that the number of uninsured Americans will reach 52 million in 2010. Among workers not covered by a dependent or by a public program, the fraction who are uninsured is expected to increase sharply, rising 2.1 percentage points between 2007 and 2010 and reaching 26.4 percent in 2010, according to Gilmer, an associate professor in the Department of Family and Preventive Medicine at UCSD, and Kronick, a professor in that department.

The Gilmer-Kronick paper is one of three papers published today on the Health Affairs Web site. The journal is also publishing an update on implementation of the Massachusetts health reform and coverage expansion by Sharon Long and Paul Masi of the Urban Institute, as well as a Perspective on the Long-Masi paper by Jon Kingsdale, the executive director of the Commonwealth Health Insurance Connector Authority in Boston, Massachusetts.

The Gilmer-Kronick Model

The projections by Gilmer and Kronick are based on their coverage affordability index, which estimates the affordability of health insurance by dividing per capita health spending among insured Americans by the median personal income for American workers. 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 use the historical relationship between coverage rates for workers and for all nonelderly adults to generate predicted uninsurance rates for all nonelderly adults.

Kronick and Gilmer have earlier demonstrated that their model adequately explained changes in the rate of uninsurance from 1979 through 2002. In their new paper in Health Affairs, in addition to projecting coverage changes through 2010, the researchers demonstrate that their model also accounted very well for variations in the uninsurance rate from 2003 through 2007.

Accounting For The Recession

Gilmer and Kronick's projections partially take the current economic downturn into account because sluggish growth in personal income for American workers is a key factor driving the results. However, because their model is based on extrapolating from uninsurance rates among workers, it does not directly take into account the effect on uninsurance of the significant job losses that occur during recessions and that have been particularly pronounced in this recession. The Gilmer-Kronick model has a mixed track record during recessions: It fit the data quite well during the relatively mild recession of 2001-03 (primarily because health care costs increased rapidly and that led to a rapid increase in the predicted number of uninsured people), but the model underpredicted coverage losses during the recession of 1991-92.

"Because of the number of Americans who have lost their jobs or will lose them in the coming months, the increase in the number of uninsured people is, if anything, likely to exceed the projections in this paper. In the recently enacted economic stimulus legislation, Congress provided a 65 percent subsidy toward continuation coverage for a subset of laid-off workers. That will help, but our research demonstrates once again the importance of more comprehensive action to extend adequate and affordable health coverage to all Americans," said Gilmer.

After the embargo lifts, you can read the article by Gilmer and Kronick at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w573


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2009 Project HOPE–The People-to-People Health Foundation, Inc.