A record rise in the number of people without health insurance across the nation is fueling renewed debate over a health care law that could to work better at boosting coverage than controlling costs. More than 50 million people were uninsured last year, almost one in six U.S. residents, the Census Bureau reported Thursday. The percentage with private insurance was the lowest since the government began keeping data in 1987.
The reasons for the rise to 50.7 million, or 16.7%, from 46.3 million uninsured, or 15.4%, were many: workers losing their jobs in the recession, companies dropping employee health insurance benefits, families going without coverage to cut costs. Driving much of the increase, however, was the rising cost of medical care; a Kaiser Family Foundation report shows workers now pay 47% more than they did in 2005 for family health coverage, while employers pay 20% more.
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Although the health care law signed by President Obama in March is designed to insure an additional 32 million people in public and private programs, it doesn't fully kick in until 2014. For the next few years, experts say, the problem could get worse. The average cost to insure a family of four is already about $14,000.
"Eventually, more people will be covered if everything goes the way it should starting in 2014," says Helen Darling, president of the National Business Group on Health, which represents large employers. "But that's four years away, and there's going to be a lot of financial pain and economic burden before 2014."
The increase in the uninsured population had been expected as employers continue to shed jobs. Those in low-income households were three times as likely to be uninsured as those with incomes above $75,000. Workers ages 18-64 were the primary losers, as public programs such as Medicare, Medicaid and the Children's Health Insurance Program protected the young and aged.
President Obama picked up on that glimmer of hope in his response to the Census report. He said the new health care law, which is designed to insure more poor and middle-income Americans, "will build on that success by expanding health insurance coverage to more families."
Proponents of the law say the sharp rise in the number of uninsured in 2009 only makes their case stronger.
Opponents say the Census report exposes the fallacy of the new law — its reliance on government insurance programs to shield low-income families from soaring medical costs. The government's health care actuary projected last week that overall health care spending would rise slightly over the next decade.
"If ever one needed an affirmation about how essential the Affordable Care Act is, this is that affirmation," says Ron Pollack, executive director of the health consumers group Families USA. "The clear message for people now is that help will be on the way."
Robert Greenstein, executive director of the liberal Center on Budget and Policy Priorities, says the decline in employer-provided insurance shows the need for state health insurance exchanges, to be created under the law. Insurers would compete in the exchanges for consumers' business.
"There needs to be some other mechanism for people ... to have a way to get coverage, other than through employers," Greenstein says.
Since its passage, the law has struggled to win public support. The latest USA TODAY/Gallup Poll found Americans disapprove of the new law 56% to 39%, though the Kaiser Family Foundation has found that many individual provisions are more popular.
"The White House and its allies won the legislative debate. They lost the debate in the court of public opinion," says Robert Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation.
Obama is likely to address the law next week as its earliest provisions — including one allowing children to remain on their parents' policies until they turn 26 — start taking effect.
At the same time, Republicans in Congress led by Rep. Steve King of Ohio are mounting an uphill drive to repeal the law. Others, such as Sen. Tom Coburn of Oklahoma, threaten to block funds needed to implement it.
Opponents in several states are challenging — in courts and legislatures and at the ballot box — the law's mandate that most people buy insurance. They say people should not be required to have health insurance and states should not be required to pay additional costs not covered by the federal government.