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Health Coverage in the Hole

Ranks of nation's, state's, and county's uninsured have been swelling

By Cheryl Smith, Fri., Oct. 6, 2006

Congrats, America, Texas, and Travis County!

Let's start at the top. The ranks of the nation's uninsured swelled for the fifth year in a row in 2005, due largely to fewer and fewer employers providing their lowly employees with health insurance. Approximately 47 million people didn't have coverage in 2005, a nearly 7-million-increase since 2000, according to a new policy brief from the Economic Policy Institute, a D.C.-based "think tank" that focuses largely on labor issues.

EPI economist Elise Gould, author of the brief, "Health Insurance Eroding for Working Families," said a combination of skyrocketing health-insurance costs and a weak labor market leaving workers with little bargaining leverage has led to employers, especially small businesses, dropping health-insurance benefits. Since 2000, health premiums have risen 87%, while inflation and workers' earnings have gone up 18% and 20% respectively, Gould said. As she put it, "Workers are really losing."

The policy brief's analysis is broken down by state for 2004 and 2005. With 55% of its population covered by health insurance, Texas had the third-lowest coverage rate in the U.S. during the two-year period. New Mexico had the lowest coverage rate, at 53%, with Montana in second place at 54.6%. While no state's coverage rate went up during the period analyzed, Texas was one of 34 states whose rate declined. (For the full report, see www.epi.org/content.cfm/bp175.)

And as if that wasn't enough bad health-care news, Medicaid enrollment in Travis and Hays counties has been on the decline. According to Austin's Center for Public Policy Priorities, adult enrollment slumped from December 2005 to June 2006 by 6.5% in Travis Co. and 10% in Hays Co. Statewide, adult enrollment rose by slightly less than 1% during that same time period. (August enrollment data indicated modest increases in both counties, according to the CPPP, but it's too early to know if that's a trend.)

The problem is the Texas Health and Human Services Commission changed last January how residents of the two counties sign up for benefits, their residents serving as pilot-program guinea pigs in the first step of Texas' much-touted plan for privatizing the public-benefits eligibility and enrollment process. According to the CPPP data, compiled from Health and Human Services Commission Medicaid enrollment numbers, enrollment glitches have the potential to screw children more than anyone. Out of the 2.6 million Texans enrolled in Medicaid as of August, 1.8 million were children. Gould concluded in her policy brief that children aren't faring well on the health-coverage front nationwide. According to her research, the country's overall percentage of uninsured children in 2005 rose for the first time since 1998.

In Travis County, enrollment in the state's Children's Health Insurance Program has also been down: from 52,667 in December 2005 to 49,970 in August 2006, according to the CPPP. "We've got the worst of both worlds, basically," said center Associate Director Anne Dunkelberg of the health care situation in both Texas' public and private sectors.

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