The ranks of the uninsured grew by 2.4 million in 2002 as jobs disappeared and employers cut back on health benefits, according to figures released Monday.
An estimated 43.6 million Americans were without health-care benefits in 2002 - a second consecutive increase that mirrors the rise in poverty and the drop in median income reported last week by the U.S. Census Bureau.
"These numbers are huge," said Ron Pollack, executive director of Families USA, a consumer advocacy group. "The number of people who are uninsured now exceed the cumulative population of 24 states plus the District of Columbia."
The nation's uninsured ranks went up from 14.6 percent in 2001 to 15.2 percent in 2002, according to census bureau figures.
Most of that increase resulted from a drop in the percentage of people insured through employers. Middle-income people lost coverage at a rate that alarmed some experts, while Hispanics and the poor remained among the groups with the highest uninsured rates.
About a third of all Hispanics are without health-care benefits and foreign-born residents are nearly three-times as likely to be uninsured as native-born Americans.
The report also showed increased uninsured rates among whites, blacks, young adults and higher-income families.
Jacqueline McKenzie, originally from Jamaica, has never had a job in Florida that provided health care benefits. Employed as a home health aide and a data entry clerk, she resorts to home remedies instead of going to a doctor.
When she does see a doctor, she said, it means doing without something else: new shoes for her daughter, something nice for the house.
"You avoid the things you don't need," said McKenzie, 33, of Orlando. "You would like to have it, but the medications are more important."
In Florida, the percentage of uninsured people was 17.4 percent for 2002 - essentially unchanged from 2001.
But the lack of change is misleading, health experts said. Florida ranked fourth among states with the largest number of people - 4.6 million - who did not have health coverage for at least part of 2002, according to a recent study by Families USA.
"The census figures give Floridians no reason to rejoice," Pollack said.
Central Florida's hospitals report a continued increase in visits by uninsured patients.
Florida Hospital, for example, said the number of people without coverage who were discharged from the hospital rose 12.4 percent in 2002 to 6,049. Hospital officials blamed the increase on the weak economy and the region's reliance on service-oriented companies, which often don't offer health benefits.
Dr. George Ellis, chairman of the Primary Care Access Network, a coalition that includes a dozen health clinics in Orange County, said the clinics have seen an increasing number of uninsured patients in recent years.
"We know that the number of uninsured has gotten worse," Ellis said.
Caly Ramos, supervisor of the Central Florida Family Health Center on South Semoran Boulevard, estimated that half of the 80-90 adults her two doctors see each day are without health-care insurance.
Walter Rojas, a 58-year-old machine operator from Colombia, said he has been unable to find work with an employer who provides health insurance since moving to Florida three years ago from Philadelphia. Rojas said he came to Florida for the climate, but the lack of health care benefits has made it a costly move.
"The weather is very expensive here. We're paying for the sun," said Rojas, of Orlando, Fla.
Last year, when Rojas needed a prostate operation, doctors estimated the procedure would cost him $40,000. Instead, he bought a plane ticket back to Colombia and had the operation for $800.
"This is the richest country, the best country, but we don't have any benefits for the poor people. It's a shame," Rojas said.
To some, the latest census figures contained telling signs that poor people are no longer the only ones struggling to obtain affordable health coverage.
The largest increase in the uninsured was among the 14.6 million Americans with household incomes between $25,000 and $49,999, whose numbers grew 1.5 percent. But high-income people suffered as well - 7.5 million people with household incomes of $75,000 or more had no coverage in 2002, up from 6.6 million the previous year.
Once people lose their jobs, they find that health coverage can be prohibitively expensive, said Paul Ginsburg, president of the Center for Studying Health System Change, a non-partisan research group.
"The numbers imply that this is a middle-class phenomenon," Ginsburg said. "It says something about the affordability of care."
According to the census, about 30 percent of those ages 18 to 24 did not have health insurance last year.
When Alicia Cuentas was younger, she didn't think she needed coverage.
All that changed when a doctor discovered an ovarian cyst a few years ago. The operation cost $12,500, but her employer's health insurance paid all but $250, she said.
"If not for the insurance, I'd be in debt forever," she said.
Cuentas after she left that job, the primary criteria in her job search was a company that offered health-care benefits. It has become more important to her, she said, than the salary.
"I really wanted to work for a company that has health insurance," said Cuentas, 42, of Orlando. "It means they care about their workers, even if they don't pay us much. I feel more secure."
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