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“Why should a sick person in Connecticut have access to health care when they don’t in Mississippi and Texas?” Sawhill asked. “We really do have a very high level of poverty as a result of the recession. And the safety net is weaker than ever.”

Medicaid, the nation’s single largest insurer, is a state and federal program created in 1965 as a companion program to welfare cash assistance to single parents. Today, the elderly and disabled cost nearly 70 cents of every Medicaid dollar, not the stereotypical single mother and her children.

What’s largely unknown to many Americans is who is left out of the safety net, said Cheryl Camillo, a senior researcher at Mathematica Policy Research. “A huge chunk of the populace is not covered, even by Medicaid,” she said.

The political rhetoric during a presidential campaign focuses on the middle class and leaves the uninsured working poor largely invisible, said Rand Corp. researcher Dr. Art Kellermann.

“We hear a lot of talk about unemployment and the aspirations of middle-class Americans. But we don’t hear about the consequences of unemployment and the consequences of the collapsing middle class,” Kellermann said. Losing health insurance is one of those consequences.

“It’s like the public just doesn’t want to believe anything else until it hits home,” he said, “Until it’s their own child, brother or parent that got laid off when they were 58, until then, it’s not real.”

AP medical writer Carla K. Johnson reported from Chicago. AP writer Christopher Sherman contributed to this report from San Juan, Texas.