Study Shows More People Go Without Health Coverage as Insurance Costs Outpace Income Eightfold

What's happened in each state since the 1994 federal health reform debate is chronicled in a state-by-state analysis released during 'Cover the Uninsured Week.'

    • March 24, 2009

With Congress and the Obama administration discussing how to reform the nation’s health care system, a new report looks at what has happened since the last significant reform effort ended in 1994 without any comprehensive congressional action. The analysis from the Robert Wood Johnson Foundation (RWJF) documents the deteriorating scenario unfolding since then:

  • Nationwide, nearly 9 million more Americans are uninsured.
  • Six million more working people are uninsured in the United States.
  • Nationwide, average costs paid by an employee for an individual health insurance premium have risen nearly eight times faster than average U.S. incomes.
  • The percentage of nonelderly people with private health insurance has decreased to just 67 percent, down 6 percentage points nationwide. 

“The case for reform couldn’t be clearer,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “Further inaction means that costs rise, businesses struggle, and workers go without. As high as the numbers of uninsured people seem to be, they don’t even reflect the current crisis with millions of Americans losing their jobs, which puts their insurance status in jeopardy. And the more people who become uninsured, the harder it is on our health care system.”

The report— At the Brink: Trends in America’s Uninsured 1994-2007—chronicles state-by-state health coverage trends. Over the last 15 years, nearly every state has seen increased numbers of uninsured residents, greater costs for workers while their incomes are flat, and significant erosion of private coverage. The report was prepared by the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota. Researchers averaged data from the U.S. Census Bureau from 1994-1996 and compared it with average figures from 2006-2007. The report shows:

  • More Americans are uninsured. Nationwide, the total number of uninsured has increased by nearly 9 million, to 45.7 million. Across the U.S., 22 percent of men are uninsured, up from 19 percent; 18 percent of women are uninsured, up from 16 percent.
  • More working people are uninsured. Nationwide, the number of working uninsured adults has increased by more than 6 million, to 26.9 million. Currently, nearly one in five working adults (18 percent) is uninsured.
  • More kids have insurance. Nationwide, the rate of uninsured kids has fallen by 13 percent, to 9.2 million, which experts attribute to more children being covered by government insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP).
  • Fewer people have private health insurance. Nationwide, the percentage of nonelderly people who have private insurance has dropped to 67 percent, down from 73 percent. Alaska, North Carolina, Utah, Vermont, and Virginia have all seen the percentage of privately insured residents erode by 10 percent or more.
  • Workers’ insurance costs have risen far faster than incomes. Average costs for an individual insurance policy have increased 61 percent—from $2,560 in 1996 to $4,118 in 2006. Nationwide, the amount that employees pay for an individual policy has increased 79 percent, with wages in the U.S increasing just 10 percent over the period.

“The rising cost of health care has largely been borne by workers who are not getting raises because of it and employers who are seeing these costs eat into their profit margins,” said Lavizzo-Mourey. “Fixing our broken health care system is a critical part of fixing the economy, but it will not happen overnight and it won’t be easy. Fortunately, a lot of people are working together this time—government and business, doctors and patients, Democrats and Republicans—so that we can achieve real reform. When all Americans have access to affordable health care, everyone will benefit.”

The report is being released during Cover the Uninsured Week, a nonpartisan campaign organized by RWJF to advocate for health coverage for all Americans. Now in its seventh year, Cover the Uninsured Week (March 22-28) has become the largest, nonpartisan mobilization in history seeking solutions for the millions of Americans who are uninsured. Thousands of people will participate in Cover the Uninsured Week events held across the nation. To learn more, log on to www.CoverTheUninsured.org.  


The Robert Wood Johnson Foundationfocuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

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