The number of moderate-to-middle-income Americans of working age who lack health insurance has risen dramatically in recent years, a study to be released today found.

Forty-one percent of adults with incomes between $20,000 and $40,000 a year did not have health insurance for at least part of 2005, up from 28 percent without coverage in 2001, according to the report by the Commonwealth Fund, a New York-based health care policy foundation.

The report illustrates how employers are dropping health coverage or are offering insurance plans that are too expensive for many workers to afford, according to the authors.

"These findings paint a disturbing picture of the day-to-day impact of being uninsured on the physical as well as financial health of millions of Americans," Sara Collins, the Commonwealth Fund's senior program officer and lead author of the study, said in a statement.

The Commonwealth study found that the percentage of individuals earning less than $20,000 a year without insurance rose to 53 percent, up from 49 percent in 2001. Overall, the percentage of people without insurance rose to 28 percent in 2005 from 24 percent in 2001.

About 45.8 million Americans did not have health insurance in 2004, according to the U.S. Census Bureau. Almost 7 million Californians are uninsured.

Nationwide, fewer employers offer coverage. And those that do are asking workers to pay more for what is, in most cases, less coverage.

The percentage of businesses offering health benefits to their workers dropped to 60 percent in 2005 from 69 percent in 2000, according to the latest annual report on employer-sponsored health insurance by the Kaiser Family Foundation and Health Research and Educational Trust.

That report found the $10,880 average annual premium for a family of four in 2005 surpassed the yearly gross earnings of $10, 712 for a full-time minimum-wage worker. While employers pay most of that premium, workers are covering about 25 percent.

More than half of 4,350 people surveyed in the Commonwealth study said they had medical debt or bill problems. More than a third reported problems or delays in getting care due to costs. Nearly two-thirds of adults with problems paying medical bills said they or a family member was insured when they incurred the debt.

Medical debt has become a growing problem among people with insurance. A Harvard University study released last year found that almost half of those who filed for bankruptcy in five states, including California, cited illness and medical bills as a major reason. More than 75 percent had insurance at the onset of illness.

The Commonwealth report also found that 59 percent of uninsured people with chronic conditions such as asthma or diabetes either skipped a dose of their medicine or went without it because it was too expensive.

The same group also was more likely to visit a medical emergency department. About 35 percent of uninsured adults with a chronic condition went to an emergency room, sometimes staying overnight in a hospital, compared with 16 percent of insured Americans with a chronic condition.

"The uninsured are more likely to go without preventative care or screening tests that could prevent more serious and costly health problems," Collins said.

Health advocates said the findings confirmed their own observations.

"Between employers dropping coverage and health care costs going up, the uninsurance crisis is reaching more broadly across the population," said Anthony Wright, executive director of Health Access, a coalition of California community and labor groups. "That's especially true in California, which already has one of the highest costs of living."

_____________________________________________

Victoria Colliver, Chronicle Staff Writer

The Associated Press contributed to this report. E-mail Victoria Colliver at vcolliver@sfchronicle.com.

Page A - 1
URL: http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/04/26/MNGFEIFEGT1.DTL

©2006 San Francisco Chronicle