A number of companies are dropping health insurance programs or demanding that employees shoulder a bigger share of rising insurance premiums. Many businesses across the country offer no health-care coverage at all. In California, the National Federation of Independent Businesses reports that 42 percent of its 37,000 members provide none.

The census figure does not include thousands of immigrants working in low-wage jobs that do not provide benefits. They are barred from medical aid as a result of changes to welfare rules in 1996 under the administration of William Clinton. Those changes restricted immigrants’ access to programs such as Medicaid and the Children’s Health Insurance Program.

According to the government agency, 41.2 million people--14.6 percent of the population--lack health insurance, an increase over the previous year, when 14.2 percent went without coverage. The largest group of people who lost their medical benefits--some 800,000 people--had incomes of more than $75,000 a year. They had either lost their jobs or were unable to afford the rising cost of insurance premiums.

The steady rise in the number of those without health insurance dates back more than a decade to the 1990–92 recession, when it increased to 35.4 million from 32.9 million. Despite the ballyhooed "boom" years of the mid- to late 1990s, the number of those without medical coverage continued to rise, reaching 40.7 million in 1998.

The growing number of bankruptcies rolling across the country, and the drain in value of many pension plans over the past two years due to falling stock prices, have demolished or endangered the company-paid health insurance or retirement benefits that many workers have been relying on.

The federal Cobra program, established as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, was set up to allow workers who recently lost their jobs to maintain their health coverage for up to 18 months if they assumed the full cost of the coverage that had been provided by their former employer. Only 25 percent of workers say they could afford to keep their health insurance under that program, according to a survey by the research group Commonwealth Fund.

In face of the economic slowdown, state government officials are pleading "fiscal crisis" as they sharpen their budget knives to slice more from government-provided Medicaid and Medicare. Such health programs account for 30 percent of state budgets.

"You will see huge cuts in Medicaid" next year beyond the cutbacks already enacted, said Raymond Scheppach, director of the National Governors Association. "This is the worst fiscal crisis states have had since the second World War," he added, after releasing the association’s "Fiscal Survey of States." In addition to cutting Medicaid eligibility and benefits, he said, state administrations would increase tuition at colleges and universities, raise taxes, and lay off state workers.

Meanwhile, President Bush is spearheading a bipartisan assault on social entitlements--a hallmark of the Clinton administration--with proposals for more reductions in Medicare payments for a wide range of prescription drugs and medical devices used to treat patients who are elderly or disabled. Those cuts include Medicare coverage for cardiac defibrillators, blood products for transfusions, and cancer drugs. One third of elderly people in the United States have no prescription drug insurance.

Those who need health care the most face the steepest medical cost increases. Out-of-pocket expenses for Medicare enrollees who are in poor health are estimated to rise by 34 percent to $4,783 this year, up from $3,578 in 2001. Working people confronted with major illnesses who seek Medicare benefits will have a more difficult time obtaining life-saving drugs, devices, and medical treatment.  
 
 
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