Worker health benefits slipping

32% of nation's uninsured toil at large companies

Rate is up from 25% in 1987

Number without coverage at smaller employers dips

October 22, 2003|By KNIGHT RIDDER/TRIBUNE

A third of the nation's workers without health insurance are employed by large companies, the employers traditionally most likely to offer coverage to their workers.

And the numbers are rising, according to a report released yesterday by the Commonwealth Fund, a private foundation supporting independent research on health and social issues.

Large companies account for a larger portion of uninsured workers than in the past. Workers at large companies made up 25 percent of the uninsured work force in 1987. In the latest statistics cited by the study, they account for 32 percent of all uninsured workers.

The trend has ominous implications at a time when the number of uninsured is rising overall.

Nongovernment employers form the backbone of the nation's private health insurance system, with large companies bearing the lion's share of the costs.

Sixty percent of the population younger than age 65 receive health coverage through an employer.

From 2000 to 2002, the number of uninsured rose by 10 percent to nearly 44 million people, according to the U.S. Census Bureau. The number of insured workers also rose.

Researchers found that while the proportion of uninsured at large companies (those with more than 500 workers) rose from 1987 to 2001, the proportion of uninsured workers at small and mid-size employers declined.

From 1987 to 2001, the rate of uninsured workers has risen faster at large companies than at employers of any other size, the report found.

"Policy-makers seeking solutions to the growing uninsured problem must look beyond workers in small firms, or they risk leaving out a large group of low-wage uninsured workers," said Jeanne Lambrew, associate professor of health policy at George Washington University and one of three authors of the report.

The report found that:

Whether a worker is insured depends largely on the access to coverage provided by the employer. More than 70 percent of uninsured workers at large companies said they lacked access to job-based health coverage.

At large and smaller companies that offer health coverage, uninsured workers tended to be low-income employees and were less likely to be married than insured workers were.

Large companies are more likely than small ones to offer health coverage. The largest companies - those with more than 1,000 employees - are nearly 10 times more likely than the smallest companies to offer health insurance.

Large companies with employees scattered among smaller locations are less likely to offer health coverage than are large employers with concentrated work forces.

Researchers noted the factors leading to the declining rates of insured workers at large companies:

Stagnant wage growth. Low income is strongly tied to lack of health coverage.

Declining rates of unionization. The rate of workers in unions declined by one-third at large companies from 1987 to 2001, a greater decline than at small and mid-size employers.

A decline in manufacturing jobs.

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