Report Singles Out Hispanics as Biggest Group Among 59 Million Uninsured

WASHINGTON May 13, 2004 (AP) - The widely used estimate that 41 million Americans lack health insurance year-round may be double the real figure, the Congressional Budget Office says, an estimate that could roil the debate over reshaping the nation's health care system.

The nonpartisan budget office issued a study Monday estimating that 21 million to 31 million people are without coverage all year. Overall, at least 59 million are uninsured at least briefly in a given year, the report said.

Monday's report could fuel the arguments of both political parties as they prepare to tackle the issue in Congress and on the 2004 campaign trail.

Republicans, who generally favor less costly approaches, could cite the budget office's conclusion that there are fewer people without coverage all year than the 41.2 million estimated by the Census Bureau.

Democrats could use the 59 million estimate for Americans who lack insurance for at least some period to argue that the need is even more widespread.

"There are two problems, short spells and long-term uninsurance,'' Douglas Holtz-Eakin, the agency's director, said in an interview. "There is no such thing as the typical uninsured.''

Though there is no doubt that extending coverage to more people would be hugely expensive, defining the problem's magnitude is significant because it will affect which policies lawmakers might design to address it.

The issue has already emerged as a crucial issue among the Democratic contenders for their party's nomination.

The budget office said nearly half the 59 million uninsured in a given year are without insurance for less than four months. An additional 30 percent are uncovered for more than a year, the report estimated.

The biggest demographic group likeliest to face long periods without health care coverage are Hispanics, the report said.

The analysis by the budget office was based on data from the Census Bureau and other federal sources for 1998, which the report said is the most recent year for which there is reliable data.

The Census Bureau's estimate last September that 41.2 million people were uninsured for the entire year covered 2001.

Holtz-Eakin said the Census Bureau's data is overstated because survey respondents asked to report their circumstances during the previous year often end up describing their current situation.

He arrived at that conclusion by comparing the data to other Census reports in which people are repeatedly interviewed every few months, and using statistics gathered by the Centers for Disease Control and Prevention, and from the Agency for Healthcare Research and Quality. Both are branches of the Department of Health and Human Services.

The Census Bureau did not immediately respond to a request for comment.

Almost all Americans age 65 and older are covered by Medicare, the health insurance program for the elderly and handicapped. The budget office and Census estimates covered people too young to qualify for Medicare coverage.

Last month, presidential contender Rep. Dick Gephardt, D-Mo., announced a plan to repeal all the tax cuts Bush has pushed through Congress and use the money to cover nearly all uninsured Americans. The highlight of his proposal — which overall would cost more than $200 billion a year — would use refundable tax credits to subsidize companies' costs of insuring their workers.

Another candidate, former Vermont Gov. Howard Dean, is proposing a plan his aides say is half as costly as Gephardt's but would help more Americans. He would offer tax incentives to companies that provide coverage, and create a refundable tax credit for uninsured people who can't afford even reduced premiums.

Sen. John Kerry, D-Mass., plans to offer his health care proposal on Thursday.

Bush has proposed spending $89 billion over the next decade for a tax credit that would subsidize up to 90 percent of the costs of health insurance for low- and middle-income people.