For New Yorkers, having a job is no guarantee of health–in fact, it can be a liability. A September report by the nonprofit United Hospital Fund found the number of uninsured New York State residents grew 40 percent between 1991 to 1996. And because only the poorest people are eligible for public health benefits, part-time workers actually are less likely to have insurance than people with no job at all.

Nationwide, 17.6 percent of all Americans have no health insurance. But in New York state, that number is closer to 20 percent. The responsibility for this decline in health care coverage falls at the feet of employers, says the report.

Nearly three-fourths of uninsured New Yorkers have jobs, many of them full-time. Only 60 percent of all employees at smaller companies–ones with less than 24 employees–have insurance. And many low-wage jobs don’t offer insurance at all.

“As premiums have gone up, employers have been dumping coverage or are less likely to cover employees,” said Megan Toohey, health policy analyst at the UHF. “A first step employers take is not to allow family coverage. A lot of people find that their spouse or children are not covered.”

And New York City’s even less insured. Nearly a third of all city residents lack health insurance. Even though the city is home to 41 percent of the state’s residents, it accounts for 60 percent of its uninsured. As Toohey explained, New York City has a high concentration of small business, which are less likely to provide insurance. It also has a lot of immigrants, a group less likely to be insured through their jobs.

Recent policy shifts may make the trend worse. Managed care and payment caps, with their tighter budgets and stricter accountability, have hobbled public hospitals that care for the poor.

Medicaid and other state health funds have been covering more of the poorest in recent years, but those numbers are expected to decline as welfare reform forces people off the rolls and away from entitlements.

The report also found that:

— Forty-six percent of the state’s immigrant population is uninsured.

— While the state trails the nation in overall health coverage, more New Yorkers receive public insurance–Medicaid and programs like Childrens Health Plus.

— 285,000 New York children are eligible for Medicaid, but are not enrolled.

— Single, childless adults are more likely than married parents to be uninsured.

To obtain a copy of “Taking Steps, Losing Ground: The Challenge of New Yorkers Without Health Insurance,” call 212-494-0700.