updated 10/31/2003 6:01:47 PM ET 2003-10-31T23:01:47

A third of the nation’s workers without health insurance are employed by large companies, a study says.Thirty-two percent of all uninsured workers in 2001 were employed by big companies, up from 25 percent in 1987, according to the report released Tuesday by The Commonwealth Fund.

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Researchers citied as factors soaring health care costs, declines in manufacturing and union jobs and the changing structure of large corporations — those with more than 500 employees — and the benefits they offer.

“Policy-makers seeking solutions to the growing uninsured problem must look beyond workers in small firms, or they risk leaving out a large group of low-wage uninsured workers,” said Jeanne Lambrew, an author of the study and an associate professor of health policy at George Washington University.

The study also noted that seven out of 10 uninsured workers at large companies were not offered health insurance, and 15 percent were ineligible. Low-income workers were the most likely to be without coverage.

The Census Bureau estimates that 44 million Americans were uninsured last year.

While researchers found a growing number of uninsured workers at large firms, they said the opposite was true for small and medium-sized companies.

The percentage of uninsured employees in small businesses — those with fewer than 100 workers — dropped from 67 percent in 1987 to 57 percent in 2001. Similarly, the number of uninsured workers at medium-sized companies fell from 14 percent to 12 percent during the same period.

Access to health care and employers’ rising costs have been debated in Congress and by the nine Democrats seeking to challenge President Bush next year. The issue also is at the center of numerous labor disputes in California and elsewhere.

Striking grocery workers and public transit mechanics have caused widespread inconvenience and economic losses in Southern California. Thousands of Kroger Co. grocery workers also walked out in West Virginia, Ohio, Kentucky and Missouri last week. Unions are fighting to retain top-of-the-line medical benefits while employers want workers to pick up more of the cost.

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