South Florida a hot spot for those without health insurance :JOHN DORSCHNER

A stunning 53 percent of adults ages 18-64 in Hialeah lack health insurance -- almost three times the national average. Meanwhile, only 13.8 percent of that age group in Weston are uninsured -- the lowest rate in South Florida.

Such exact numbers became available for the first time Tuesday as the U.S. Census Bureau published the most detailed information ever about where the uninsured are located, including all communities with a population over 70,000.

As the nation's leaders continue to argue about the merits of healthcare reform, the 2008 data, released as part of the American Community Survey, confirmed what has long been known -- that Florida in general and South Florida in particular have unusually high rates of uninsured.

In Florida, an average of 3.7 million are uninsured over the past three years -- 20.5 percent -- the fourth-highest rate in the country. In Broward, 21.8 percent are uninsured. In Miami-Dade, it's 28.1 -- almost twice the national average of 15 percent.

Because Medicare covers most of the elderly and various state-federal programs are available to many children, the biggest disparities appear in the 18-64 age group. More than a third of Miami-Dade residents in this category are uninsured, led by Hialeah (53.1 percent) and Miami (45.8). In Broward, Pompano Beach was highest, with 39.6 percent.

Most experts said they were not surprised to see so many uninsured in Hialeah, where 95.9 percent of the population is Hispanic, according to the latest Census data. ``The highest rate of uninsured in the country are Hispanics,'' noted Steven Ullmann, a health policy expert at the University of Miami.

The latest Census data show that 30.7 percent of Hispanics were uninsured in 2008, down slightly from 32.1 percent in 2007. For non-Hispanic whites, it was 10.8 percent in 2008, up from 10.4. For blacks, it was 19.1 percent, the same rate as 2007.

Overall, the latest Census data show 46.3 million were uninsured in 2008, up slightly from 45.7 percent in 2007, but some experts think the present numbers may be considerably higher because of the waves of layoffs caused by the recession.

A CITY'S EVOLUTION

Dario Moreno, director of the Metropolitan Center at Florida International University, noted that the present lack of benefits shows how much Hialeah has changed. ``Hialeah used to be the most unionized city in the South, with a manufacturing base of textiles and plastics and other products. And you think of Eastern Airlines, Pan American used to be here. Those were good paying jobs, with health insurance.''

That's changed. Hialeah now tends to be an area of service-sector jobs for small businesses, which usually can't afford to provide benefits.

Hialeah residents of all ages tend to have high uninsured rates: 28 percent of kids lack coverage, more than three times the national average. Five percent of those over 65 are also uninsured, according to the Census tables. One possibility for such high numbers is that the people are recent immigrants who do not qualify for government programs.

For health coverage, the best place for children in South Florida is Weston, where a mere 3.8 percent don't have coverage -- a third of the national average. The worst place in South Florida: Pompano Beach, where 30.2 percent of children lack insurance.

CHILDREN'S COVERAGE

Ullmann pointed out that expanding children's coverage in government programs could have longterm health benefits. He cited surveys that show only 5 percent of children on Medicaid lack a usual source of care while 29 percent of uninsured kids don't have a regular place for treatment. ``That means more pressure on the utilization of emergency rooms,'' where treatment is much more expensive than in doctors' offices.

Alan Sager, a health policy expert at Boston University, said the latest data reemphasize the great disparities in healthcare in America. ``We've long known that the states vary tremendously, from about 3 to 5 percent in Massachusetts to well over 20 percent in Texas. And so it seems all too reasonable to fear there might be even bigger gaps in smaller geographic areas.''

Unlike European countries, Sager said, the size of one's employer often determines whether a person has health coverage.

Gerard Anderson, a professor of health policy at Johns Hopkins, said that, under certain reform proposals, uninsured workers or their employers in places like Hialeah could be required to start contributing to healthcare programs. ``They could be taking a hit.''