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Cost, policies prevent millions of Americans from having health insurance


WASHINGTON (AP) _ Millions of Americans lack health insurance and, with the economy floundering, that is likely to increase, the National Academy of Sciences reported Thursday.

``Unless health insurance is made more affordable, the number of uninsured Americans is likely to continue growing over time,'' said Mary Sue Coleman, co-chairwoman of the committee that wrote the report. She also is president of the Iowa Health System and the University of Iowa, Iowa City.

The report is the first of six planned by the Institute of Medicine over two years. The series is planned to find out who lacks health insurance and why, determine what the consequences are and provide the groundwork for debate on how to correct the problem.

The institute is part of the academy, a private organization chartered by Congress to advise the government of scientific matters.

This first report seeks to draw a picture of the millions who lack insurance. It does not offer any recommendations.

The Census Bureau reported last month that 38.7 million Americans went without coverage for all of 2000, compared with 39.3 million the year before, thanks to the booming economy. Experts say the trend is likely to reverse this year, given that the economy was slowing even before the Sept. 11 terrorist attacks.

``More than the state of the economy,'' Coleman said in a statement, ``the rising cost of health care services and insurance premiums, combined with a hodgepodge of policies and practices, undermines affordability for employers, their workers and the public at large.''

About two-thirds of Americans under age 65 are covered by health insurance through their job or that of a relative, the report found.

That means many people gain or lose coverage as they marry or divorce, change jobs, start or graduate from college or go through other transitions.

At some point, one out of seven Americans goes without coverage for a full year; many others lack coverage for shorter periods.

The report said that with insurance costs rising, more employers and individuals may conclude they are unable to afford coverage.

Premium increases were often absorbed by employers in the strong economy of the 1990s, but that may not continue as the economy softens, the report said.

Workers now pay an average of 14 percent of the cost of individual coverage and 27 percent for family coverage, with their employers paying the rest, the report said.

The panel found that about 13.6 million of the uninsured work for employers that do not offer health insurance. Individually purchased coverage may be prohibitively costly.

In the case of such public insurance programs as Medicaid and the State Children's Health Insurance Program, the report said that stringent eligibility requirements and enrollment processes can make coverage difficult to obtain and hard to keep.

Among the findings of the report:

_Despite a modest dip at the end of the 1990s and in 2000 following an extended period of economic growth and low unemployment, the number of uninsured people has grown over the long term.

_80 percent of uninsured children and adults under 65 live in working families. The uninsured population includes heads of families juggling several jobs to make ends meet. Families with two full-time wage earners have a one in 10 chance of lacking coverage.

_About 80 percent of uninsured people are U.S. citizens, and about half are non-Hispanic whites.

_People without coverage are less likely to see a doctor when they become ill or for treatment of a chronic condition.
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