The sluggish economy and rising health costs are combining to prompt businesses cut back coverage or charge their workers more for it, and states are trimming their programs for poor and low-income residents. As a result, the ranks of the uninsured now cut deeper into the middle class.
Nationally, 30.1 percent or 74,706,000 under the age of 65 have no health insurance. The highest percentage was reported in Texas, with 39.9 percent, while South Dakota had the lowest, at 21.7.
For years, Congress has stalled on how to solve the problem, but advocates hope to change that.
"I think that there's more and more interest as the problem gets larger and larger," said Sen. John Breaux, D-La., who is proposing a major overhaul of the health insurance system.
Breaux wants everyone — including workers, the elderly, the poor and veterans — to get insurance from a central system, with subsidies for those who need help paying premiums.
Others have more modest plans. Some want to expand the Children's Health Insurance Program — CHIP — which offers subsidized coverage for more than 5 million kids in low-income, working families. Some, including President Bush, want to give people tax credits to help people pay for insurance they purchase on their own.
With little consensus about which approach is best, lawmakers have done nothing to alleviate the problem since 1997, when they created CHIP.
Now a coalition of diverse groups, including business, labor and several health organizations, has come together to push the issue in hundreds of events next week.
"We are moving toward a political tipping point will that will require real and meaningful action," said Ron Pollack, president of Families USA, a liberal consumer group that is part of the "Cover the Uninsured Week." Others on board: the U.S. Chamber of Commerce, the Business Roundtable, the AFL-CIO, the American Medical Association and the Health Insurance Association of America.
Typically, the number of uninsured Americans is reported at about 41 million — those without health insurance for all of 2001. That was up from 2000 after dropping for two years.
But the figure is much larger when a longer time span is examined and when people who are uninsured for only a fraction of the period are counted.
The elderly are covered by Medicare, but nearly one in three people under age 65 went without health insurance at some point during 2001-2002, according to the analysis of Census data by Families USA.
Ninety percent of them were uninsured for at least three months, and about 80 percent were in working families.
Studies have repeatedly found that people without insurance are less likely to see doctors and more likely to be diagnosed with illnesses late.
The coalition sponsoring next week's activities includes diverse groups often at odds with each other, who have pledged to set aside their differences to push for action on the issue generally.
The week will feature more than 500 events in about 100 communities across the country, including town hall meetings, health fairs and prayer breakfasts. Clergy are getting sample sermons and encouraged to preach about the issue next weekend. Photo exhibits in Washington and New York depict the faces of the uninsured, and the issue will feature in popular TV shows, including "ER" and "Law and Order: Special Victims Unit," the coalition said.
Funded by the Robert Wood Johnson Foundation and other charitable foundations, the coalition is also spending $2.8 million to run TV and print ads in Washington and on national cable systems.
Also coming: A report from the Institute of Medicine this week on the financial and social impact that uninsured people have on communities.
The issue of the uninsured took on intense political currency in the early 1990s as the economy languished and health care spending skyrocketed. President Clinton put the matter atop his domestic agenda when taking office in 1992, but his sweeping plan to insure all Americans never made it out of Congress.