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Editor's Correspondence
January 8, 2001

Health and Health Insurance—Reply

Arch Intern Med. 2001;161(1):128. doi:

In reply

Dr Addy asks an important question: "First, who are the uninsured?" However, his impressions show some of the common misconceptions about this issue. There are several important findings from recent national studies. First, despite our robust economy over the last decade, the number of uninsured has steadily increased from 32 million in 1987 to 44 million in 1998.1 Currently, 19.1% of Americans aged 18 to 64 years are uninsured.2 We are a recession away from having 1 in 4 working-age adults be uninsured. Second, employment does not guarantee health insurance. The vast majority of the uninsured have a household with at least 1 full-time worker (60%) or part-time or part-year worker (24%).1 These workers are not uninsured by choice. Only 12% of uninsured workers declined coverage for which they were eligible; 70% worked for a firm that did not offer health insurance; and 18% were ineligible for coverage offered by their employer.3 Moreover, contrary to Dr Addy's claim that most of the employed uninsured are "entrepreneurs," the majority of the uninsured are either poor or near-poor.1 Thus, they cannot afford to buy insurance if their employer does not offer it. Finally, the statement that health care benefits are being offered even to "entry level" employees at higher rates than in the past is incorrect. The percentage of workers who said that they were eligible for insurance through their employer was 82% in 1988, but in 1997 it was only 75%.4 Much of the increase in the number of uninsured over the last 2 decades can be attributed to the fact that fewer employers are offering insurance.

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