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At a November 2005 policy briefing examining the latest health coverage trends, the Kaiser Commission on Medicaid and the Uninsured highlighted five reports profiling the growing uninsured population and the implications of the increasing strain on the nation's healthcare safety net.


New analysis found that, as the number of uninsured Americans increased by 4.6 million from 2001 to 2004, federal safety net spending per uninsured person fell from US$546 to US$498 during the same period. After adjusting for inflation, total federal spending for care for the uninsured increased by 1.3% from 2001 to 2004, whereas the number of uninsured increased by 11.2%. These trends resulted in an 8.9% decline in spending by the federal government per uninsured person.


The analysis of federal spending on the healthcare safety net, authored by Jack Hadley and colleagues at The Urban Institute, describes a patchwork of federal money dedicated to care for the uninsured. Federal support for community health centers increased by more than 50% over the past four years, but accounts for less than 3% of total federal spending on the healthcare safety net. Because more than 70% of federal support for the uninsured flows through Medicare and Medicaid, which are both under budgetary pressures, "it is unlikely that future funding will be able to close the gap or make up the difference" in the increase in the uninsured and funding for their care, according to the report.


Another Commission study, authored by John Holahan and Allison Cook of The Urban Institute and published by Health Affairs, found a 6-million-person increase in the number of uninsured from 2000 to 2004, all among adults; two thirds of that increase occurred among people with incomes below 200% of poverty (approximately US$39,000 for a family of four in 2004). Both adults and children were affected by the 4.6% drop in the number of working adults with employer insurance coverage (67.8% to 63.3%), although children were able to obtain alternative coverage through Medicaid and the State Children's Health Insurance Program.


Approximately half of the increase in the number of uninsured was among young adults (ages 19-34 years) who experienced sharp declines in employer coverage rates. Fifty-four percent of the growth occurred in the Southern region of the country, which experienced the greatest growth in both the general population and low-income population combined with the largest decrease in employer coverage. This contributed to the 3.2 million increase in uninsured people in the South alone.


A third Commission study, also authored by John Holahan and Allison Cook, investigated the extent to which immigrants contribute to the growth in the uninsured population because immigrants are disproportionately likely to be uninsured because of employment in low-wage jobs that are less likely to offer health coverage, and they face restrictions on eligibility for public coverage. However, for the period between 1994 and 2003, the study found that the growth in the number of uninsured has largely been among native citizens. Native citizens accounted for 73% of the growth in the number of uninsured persons from 1994 to 1998, and 70% from 2000 to 2003, when the economy slowed. Between 1998 and 2000, years of unusually strong economic growth and tight labor markets, there was a decrease in the number of uninsured native citizens, whereas the number of uninsured noncitizens increased by 800,000.


For a first-hand look at these reports, Federal Spending on the Healthcare Safety Net from 2001 to 2004: Has Spending Kept Pace with the Growth in the Uninsured?, Changes in Economic Conditions and Health Insurance Coverage, 2000 to 2004, Are Immigrants Responsible for Most of the Growth of the Uninsured?, Threadbare: Holes in America's Healthcare Safety Net, and Health Coverage in America, 2004 Data Update, please visit Kaiser Commission on Medicaid and the Uninsured on the Web at In addition, the Webcast of a policy briefing in Washington, DC, on these issues can be viewed at the following link: