In Health Care Debate, Key Number Gets Bump

Updated on September 10, 2009.

A new estimate of the number of Americans without health coverage showed little change from the prior year, but the data could still fan the flames on both sides of the ongoing national debate over health-care reform.

The report on health insurance, poverty and income released Thursday by the Census Bureau shows that the number of uninsured Americans – a figure often cited in the push for universal coverage and scrutinized in the pushback against it – ticked up slightly in 2008. The number of people without health insurance rose to 46.3 million last year (15.4% of the population), up slightly from 45.7 million in 2007 (15.3%) – a statistically insignificant change, according to the Census Bureau.

“The increase [in the number of uninsured] was not as large as you would expect given the recession” and high unemployment rate, says Brad Herring, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

One reason why the overall number of uninsured people increased by fewer than expected: The expansion of government safety-net programs like Medicaid and SCHIP for the poor may have helped workers laid off during the recession retain coverage. The percentage of people covered by government health insurance increased to 29.0% in 2008, up from 27.8% in 2007, according to the report.

The new numbers were released less than a day after President Obama reiterated his case to Congress and the nation for overhauling the health-care system.

The Census data came with some caveats. The results were collected in March 2009, but the survey asked respondents if they had coverage at any time during 2008. Someone who had insurance for the first half of the year and then lost it would have been counted as having medical coverage. Given that 3.85 million people have lost their jobs this year through August, according to the latest figures released by the Labor Department, the number of people without insurance in 2009 could be far greater, barring a broad economic pickup at the end of the year.

For those recently without coverage, navigating the health-care landscape can seem daunting. While Congress debates reform and the expansion of coverage, here’s how the uninsured can regain insurance on a tight budget.

If your company has more than 20 employees and you lose your job, you can extend your coverage through Cobra for up to 18 months.

Cobra allows you to continue the plan you had under your employer, and no pre-existing medical conditions will have an impact on cost (like they might with a private plan).

The biggest barrier to entry is the cost. Monthly premiums averaged $400 for individuals and $1,200 for family coverage, according to the latest data from eHealthInsurance, an online insurance marketplace. But the stimulus bill is helping to reduce those costs by providing a 65% subsidy for laid-off workers who pay for Cobra. Those eligible will pay just 35% of the premiums. The subsidy is available to workers who lose their jobs between Sept. 1, 2008, and Dec. 31, 2009, and is limited to nine months.

You can also take steps to lower your future financial burden if you think your job or company is on shaky ground. During your employer's open-enrollment period, you can shift to a lower-cost plan at work. That way, if you need Cobra coverage later on, your premiums will be lower. It’s still going to be expensive, but moving from a PPO to a less-pricey HMO now could end up saving you a chunk of change each month, says Sam Gibbs, a spokesman for eHealthInsurance.

To be eligible for Cobra, workers must have been enrolled in their employer's health plan when they worked, and the plan must continue to be in effect for active employees. That means if your company declared bankruptcy and is liquidating its assets, it will likely terminate its health plans, making Cobra unavailable.