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As the recession peeled away thousands of jobs in Sonoma County, the number of residents under age 65 without health insurance swelled by 25,000 in just two years, state records show.

More than 80,000 residents under 65 — one out of five people in that age group — were without insurance for all or part of 2009, according to the latest California Health Interview Survey.

Their ranks swelled by 43 percent during the depths of the recession, far outstripping an 11 percent increase statewide from 2007 to 2009.

Sonoma County had the highest rate (19.7 percent) of uninsured people under 65 in the nine-county Bay Area, but came in a little below the statewide rate of 21 percent.

Two out of three of the state's uninsured will become eligible for coverage in 2014 under the federal health care law, a report by the UCLA Center for Health Policy Research said.

Mary Szecsey, executive director of West County Health Centers, said the surge in uninsured residents was no surprise.

"Overall, I think it's the economy," she said, noting that job losses are compounded by employers who "can no longer afford health insurance for their employees."

The west county group, with health centers in Sebastopol, Occidental and Guerneville, treated 3,555 uninsured patients in 2009, up 16 percent from 2007.

Last year, the number of uninsured patients jumped to 4,466.

Sonoma County's unemployed ranks swelled by 13,900 people during the same two years that 25,000 more people became uninsured. The unemployment rate more than doubled, reaching 9.7 percent in 2009, up from 4.3 percent in 2007, according to Employment Development Department reports.

There were 25,100 people in the county unemployed in 2009, an increase of 124 percent from the 11,200 jobless in 2007.

The connection was clear, health officials and an economist said.

"When the labor market struggles to hire, health care struggles to keep people insured," said Robert Eyler, director of the Center for Regional Economic Analysis at Sonoma State University. "I would be shocked if those two conditions did not walk hand-in-hand."

Laid-off workers often can continue their group health insurance under COBRA plans, but may find them too costly without an employer's contribution to the premiums. "If you can't afford it, you go without," Eyler said.

<NO1><NO><NO1><NO>There are "negative health consequences" to being uninsured, said Mary Maddux-Gonzalez, county health officer.

Lack of insurance is the sixth leading cause of death in the United States among non-elderly adults, and uninsured adults are 4.5 times more likely to go without needed medical care than insured patients, she said.

Uninsured cancer patients are almost twice as likely to die within five years than are insured patients, Maddux-Gonzalez said.

Nearly 55 percent of the county's residents under 65 had job-based coverage all year in 2009, the health survey said. About 9 percent were enrolled in Medi-Cal and 17 percent had individual private insurance or other public coverage.

Statewide, the 673,000 people who became uninsured between 2007 and 2009 was almost evenly split between those without insurance all year and part of the year.

Sonoma County had a more disproportionate trend, with 22,000 of the additional 25,0000 people uninsured for the entire year.

The tilt toward year-long lack of insurance "points to how deep and long-lasting the recession was" with the uninsured "more persistently unemployed" in Sonoma County, said Shana Alex Lavarreda of the UCLA Center for Health Policy Research.

The federal health care law will make two-thirds of California's 7 million uninsured people under 65 eligible for coverage in 2014, according to the UCLA report co-authored by Lavarreda and released on Tuesday.

Three million uninsured Californians will gain coverage through Medi-Cal expansion and 1.7 million will be eligible for subsidies to buy their own coverage through the state's health insurance exchange.

An additional 1.2 million uninsured people will be eligible to buy insurance through the exchange without subsidized premiums. The remaining 1.1 million uninsured won't qualify for any coverage because of their citizenship status, the report said.

At 65, citizens are eligible for Medicare, which covers nearly 40 million Americans.

In Sonoma County, about 55,600 uninsured people will be eligible for coverage in 2014, but the UCLA report said it will be "a challenge" to get all those eligible enrolled in either Medi-Cal or exchange insurance.

Newly eligible people "won't necessarily know about the options or find it easy to enroll in the exchange," Szecsey said.

A network of community health centers in Sonoma, Napa, Marin and Yolo counties is gearing up to help get residents enrolled, she said.

In Sonoma County, a health care outreach campaign has enrolled about 7,000 additional children in public health coverage since 2007. That effort offers "one bright spot" in the rising population of the uninsured, said Pedro Toledo, spokesman for the Redwood Community Health Coalition, which represents <NO1><NO>health centers in the four counties.

According to the health survey, the number of Sonoma County residents age 18 and under uninsured for all or part of the year declined by 3,000 from 2007 to 2009.