Number of Uninsured Children Rises

After peaking at 529,271 kids in May 2002, enrollment in Texas's children's health insurance program plummeted nearly 44 percent to 298,731 by June of this year, state figures show. Goodman said the decline was more than offset by increases in Medicaid enrollments, but the two programs serve different populations.

The most potent force behind the recent increase in uninsured children, experts said, is the decline in employer-sponsored health insurance as rising costs prompt businesses to raise premiums or cut coverage.

The latest census figures show that a record 46.6 million Americans had no health insurance in 2005, up from 45.3 million in 2004. Among those who did have coverage, fewer were receiving it through their jobs. In 2001, for instance, 62.6 percent of Americans had employer-sponsored coverage. By last year the figure was 59.5 percent, census figures show.

Katherine Swartz, a professor at the Harvard School of Public Health, said a trend toward trimming business payrolls and hiring contract workers has made things worse. More than a quarter of 25-to-34-year-olds do not have health insurance, said Swartz, author of "Reinsuring Health." For 35-to-44-year-olds, the uninsured rate is 19 percent.

"Those are the prime ages for having kids," she said. "These are unheard of percentages of those age cohorts that are uninsured. And, of course, if they have kids, their kids are not going to have health insurance either."

Corralling rising health care costs is one way to boost the number of insured children, said Diane Rowland, executive director of the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. A more immediate step is better education and outreach because studies show that at any given time about seven in 10 uninsured children are eligible for low-cost or publicly subsidized coverage, she said.

"We lose some people because they are not aware that they might be eligible or they don't know how to go down and apply," she said.

Pride also is a factor, with some families reluctant to accept government help, said Lumpkin of the Robert Wood Johnson Foundation. "Part of our campaign is to convince them, 'You know, you pay your taxes, you might as well get the benefits,' " he said.

Researcher Madonna Lebling contributed to this report.