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ROBERT SIEGEL, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

A surprising report today from the Census Bureau. The number of Americans without health insurance is down. But there's a catch. While more people have covered this year, many analysts say that won't last.

NPR's Patti Neighmond reports.

PATTI NEIGHMOND: It's always good news to see a decline in the number of uninsured. The federal government reports that in 2007, 1.3 million more people had health insurance than in the previous year.

Karen Davis is president of research group The Commonwealth Fund.

Ms. KAREN DAVIS (President, The Commonwealth Fund): All of that decline can be attributed to improvement in government health insurance programs, which constitute the nation's safety net insurance system.

NEIGHMOND: Programs like Medicaid and state insurance plans for low income children. In fact, the biggest jump was among children — about 600,000 more children now have health insurance.

But in the private sector, the news isn't as good. The trend among small businesses to drop or curtail health benefits to employees, says Davis, continues.

Ms. DAVIS: Employers just, are finding the premiums harder and harder to afford. They don't get the same premiums as do large employers and workers are finding it harder and harder to pick up their share of the premium - that they check assistance scratch to cover the premiums.

Ms. DIANE ROWLAND (Executive Vice President, Kaiser Family Foundation): What these numbers show today is that the uninsured are not going to decrease magically even if there's been a slight decline in 2007.

NEIGHMOND: Diane Rowland is an expert on the uninsured with the Kaiser Family Foundation. Rowland says it remains a dire situation when 45.7 million Americans still have no health insurance and millions more are underinsured.

Ms. ROWLAND: And so this is going to be a big issue. It's not going away. State efforts can help to decrease this when the economic times are good, but states get in economic straits when the economy turns downward. That means federal action is most likely going to have to be there if we're ever going to address the substantial uninsured.

NEIGHMOND: Both presidential candidates have described the current health care system as costly and needing reform. John McCain and Barack Obama both suggests subsidies and tax credits to help individuals buy insurance. Obama would require all parents to cover children under 18 and he'd expand public programs to make sure children of lower-income families have coverage. And the highlight of McCain's proposal is a $5,000 tax credit for families.

The big question, says Rowland, will any of it really help, especially when the cost of a typical comprehensive insurance plan for a family of four is $13,000 a year and growing.

Ms. ROWLAND: In any reform proposal, one of the debates is going to be: At what level of income do you provide assistance to people? When are people well off enough, quote, "to be able to afford their own coverage without any assistance from the federal government?"

NEIGHMOND: The major squeeze of course, the bigger the help, the bigger the cost. And the money to pay for expanded health coverage has to come from somewhere — either from employers, including small businesses, or from individuals. Obama would require employers to either provide benefits or contribute to a fund that would provide coverage. McCain makes no such rules for employers or individuals. And neither candidate is particularly deep on details - probably a good political decision, says Rowland.

Ms. ROWLAND: I think if history provides any lessons, it's that the more detail a candidate gets before elected, the more strings are tied around them when they try to act after elected.

NEIGHMOND: One of the lessons of the Clinton health reform battles of the early '90s, says Rowland, don't be too specific too soon. Everybody will start battling it out and nothing may ever get done.

Patti Neighmond, NPR News.

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