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A MILLION LOSE INSURANCE SINCE HEALTH PLAN FADED

Since President Clinton's plans for universal health care coverage collapsed a year ago, another million Americans have lost their health insurance, a trend the Clinton administration and some private analysts say would be almost doubled by Republican proposals to rein in Medicaid spending.

Estimates of the number of uninsured Americans now run as high as 43.4 million, more and more of whom are from the working poor. The rate at which the ranks of the uninsured have been growing has increased slightly but steadily in recent years, to a current annual rate of 1.2 million, by the latest estimates.But administration officials say that Republican plans to cut projected Medicaid spending by $182 billion during the next seven years could deprive as many as nine million additional Americans of Medicaid coverage by 2002.

While that projection could be labeled as partisan because it is part of the administration's preparation for the budget battle that will open when Congress returns after Labor Day, a number of outside groups and analysts agree that Medicaid's soaring growth in recent years has acted as a brake on the rising number of the uninsured. Cuts in the program, which provides health coverage for low-income Americans, could well lead to an increase in the number of people without health coverage, they say.

Congressional Republicans contend that by transferring federal money directly to the states with reduced regulation, they can expand the number of people served while limiting the growth in spending. "We're going to change Medicaid," said Rep. Dennis Hastert, R-Ill., who is the vice chairman of the Commerce subcommittee on health, which oversees Medicaid. "We think by changing it, knocking out some of the dual federal-state bureaucracy, we can expand it."

Republicans also fiercely contest Democratic descriptions of their Medicaid plans as cuts. Under the budget resolution passed by the House and Senate this summer, Medicaid spending would increase to $124.3 billion in the fiscal year 2002. That would be up from $89.2 billion in the current fiscal year, which ends on Sept. 30, but well below the $177.8 billion that the Congressional Budget Office projects would be needed in 2002 to maintain existing levels of service for everyone who meets the eligibility standards in current law.

This new debate is a stark contrast to the arguments heard here last August. Back then, Democrats wondered whether settling for covering 95 percent of Americans was too great a compromise, while many Republicans argued that the Clinton health care plan was moving in the right direction but too far, too fast.