Diane MacPherson, of Lowell, Mass., lost her job at a relocation management company a year ago, and with it the health insurance for herself, her husband and their 4-year-old daughter. Her husband works in construction and does not have access to health care coverage at work.
Continuing her family health insurance under the federal Cobra program would have cost $931 a month, so the MacPhersons decided to insure only their daughter, at a cost of $270 a month. Two months ago, when MacPherson's unemployment compensation payments ran out, they dropped their health insurance altogether. Although her husband earns about $75,000 a year, construction work is seasonal, and they could not be assured of enough income to pay for health insurance.
The MacPhersons represent a changing portrait of the 41 million Americans who do not have health insurance today. Once thought to be a problem chiefly of the poor and the unemployed, the health care crisis is spreading up the income ladder and deep into the ranks of those with full-time jobs.
According to recently released Census Bureau figures, 1.4 million Americans lost their health insurance last year, an increase largely attributed to the economic slowdown and the resulting rise in unemployment. The largest group of the newly uninsured - some 800,000 people - had annual incomes of over $75,000. They either lost their jobs or were priced out of the health care market by rapidly rising insurance premiums, or - like the MacPhersons - both.
While it is true that the number of uninsured people rises when unemployment goes up, it is also true that the rolls of the uninsured can expand even when joblessness is going down, as it did through most of the 1990s.
The number of uninsured in the last recession, from 1990 to 1992 jumped to 35.4 million from 32.9 million. But it continued to rise even in the boom years of the mid- to late 1990s, reaching 40.7 million in 1998 before dipping slightly in 1999 and 2000.
Labor economists say that much of the job growth during the expansion of the 1990s came in small businesses and in service industries - low-wage, nonunion sectors that are much less likely to offer health insurance as a benefit to new workers. There was also a demographic bulge of young people and recent immigrants entering the work force during the decade, with many of them willing to take jobs that did not offer rich benefit packages.
What is different this time, analysts say, is that the problem is hitting middle-income and upper-income families harder because many of the job losses are in industries such as technology and telecommunications.
Thirty million Americans in working families today - 16 percent of all those in families headed by a worker - lack health care coverage, according to a four-year tracking study by the Center for Studying Health System Change, a nonprofit research group financed by the Robert Wood Johnson Foundation. An additional 16 million Americans - mostly low-income workers - are offered health insurance through their jobs but decline to take it because they get health care from government programs or it is too expensive, the study found.