By Tim Bonfield
Enquirer staff writer

While more uninsured children are getting health coverage from expanded government programs, more adults are going without insurance, especially younger workers, according to a national study of health insurance trends released Tuesday.

Those young workers are not likely to get much help soon because experts say budget-pinched states are more likely to cut Medicaid programs than to expand them.

"We're seeing a clash of cultural trends," said Heather Burdette, deputy director of the Ohio Primary Care Association.

"On one hand, Medicaid coverage for adults is tied to being employed and having children. On the other hand, people are getting married and starting families later in life," she said.

The result: younger adults, ages 19-39, are becoming uninsured faster than any other age group, according to the report issued by the Center for Studying Health System Change.

"Clearly, public insurance expansions have provided a safety net for millions of people, especially children, who otherwise probably would have lost coverage as the country moved through a recession and jobless recovery," said Paul Ginsberg, president of the center.

Overall, the nation's uninsured rate has gone up slightly - from 14.1 percent in 2001 to 15 percent in 2003.

But to maintain coverage, many more people are counting on taxpayer-supported government programs.

Such programs have provided insurance to more than 5 million children nationwide, producing a 1.6 percent reduction in the uninsured rate for children (18 and younger) from 2001 to 2003.

But the rate for younger adults went up 2.7 percent. For adults aged 40-64, the uninsured rate went up 1.8 percent.

Increasing dependence on public insurance reflects the unwillingness or inability of some people to afford the steadily rising costs of private insurance.

The report found a 5.4 percent decline in younger workers getting insurance through their employers, compared to a 2.1 percent decline for workers ages 40-64.

Help out of reach

Some workers lost their coverage by losing their jobs during the previous recession. Some young people work part-time and may not qualify for benefits. Some work for employers that don't offer benefits to anyone.

And in many cases, younger, entry-level workers cannot afford the sharply increased rates many employers have been charging to all workers.

Regardless of why they became uninsured, younger adults are least likely to qualify for government assistance, Burdette said.

Some young parents can get coverage through state Medicaid programs if they have children and meet income requirements that vary from state to state. In general, adults who don't have children must be disabled or extremely poor to qualify for Medicaid coverage.

"But young adults still get sick. They still get hurt and need medical care," Burdette says.

But for now, advocates for the uninsured continue to focus on covering children. The Robert Wood Johnson Foundation, which sponsored Tuesday's report, is calling for an even more aggressive effort to enroll children and their parents in state Medicaid programs.

Telling the public

Publicity campaigns are planned to run through September because many families don't realize they may qualify, foundation officials say.

"Without insurance, too many children are missing the regular check-ups and preventive care that will prepare them to do their best in school," said John Lumpkin, senior vice president of the foundation's health care group.

But few expect that the safety net will be extended to young adults without children. For many states, including Ohio, Medicaid already is growing too fast for budgets to handle.

"Right now, Ohio has a commission meeting monthly on Medicaid reform. All we're hearing about is different kinds of proposed cuts," Burdette said. "We'll be doing well just to maintain existing eligibility levels."

E-mail tbonfield@enquirer.com