Saturday, April 03, 2010

How Many People Are Uninsured? 50-Million? 47-Million? 37-Million?

No single topic drives the health care reform debate like the number of uninsured Americans, variously numbered in speeches and ads at 45 million, 46 million, 47 million, or even 50 million. Unfortunately, most of what we think we know about the un insured is wrong.

For the record, according to the latest figures from the Census Bureau, 45.6 million Americans currently lack health insurance. This is actually down slightly from the 47 million that were uninsured in 2006. However, those numbers don't tell the whole story.

For example, roughly one quarter of those counted as uninsured — 12 million people — are eligible for Medicaid and the State Children's Health Insurance Program (S-CHIP), but haven't enrolled. This includes 64 percent of all uninsured children, and 29 percent of parents with children. Since these people would be enrolled in those programs automatically if they went to the hospital for care, calling them uninsured is really a smokescreen.

Another 10 million uninsured "Americans" are, at least technically, not Americans. Approximately 5.6 million are illegal immigrants, and another 4.4 million are legal immigrants but not citizens.

The reality is that most people without health insurance are uninsured for a relatively short period of time.

Nor are the uninsured necessarily poor. A new study by June O'Neill, former director of the Congressional Budget Office, found that 43 percent of the uninsured have incomes higher than 250 percent of the poverty level ($55,125 for a family of four). And slightly more than a third have incomes in excess of $66,000. A second study, by Mark Pauly of the University of Pennsylvania and Kate Bundorf of Stanford, concluded that nearly three-quarters of the uninsured could afford coverage but chose not to purchase it.

And most of the uninsured are young and in good health. According to the CBO, roughly 60 percent are under the age of 35, and fully 86 percent report that they are in good or excellent health.

Finally, when we hear about 45 million Americans without health insurance, it conjures up the notion that all of those are born without health insurance, die without health insurance, and are never insured in between. The reality is that most people without health insurance are uninsured for a relatively short period of time.

Only about 30 percent of the uninsured remain so for more than a year, approximately 16 percent for two years, and less than 2.5 percent for three years or longer. About half are uninsured for six months or less. Notably, because health insurance is too often tied to employment, the working poor who cycle in and out of the job market also cycle in and out of health insurance....

An editorial in the July-August 2009 AARP Bulletin repeats the same bromide heard almost nightly on the MSM news: That there are currently 47 million Americans without health insurance. The AARP editorial goes on to argue that this situation is disgraceful; that all Americans should have "affordable health care choices"; and that in terms of reform, "the time to act is now."

The sad tale of the 47 million uninsured is, perhaps, the most emotionally persuasive argument put forth for national health care reform. But is the alleged number of uninsured reasonably accurate? Or is it, instead, a purposely misleading statistic designed to advance a specific reform agenda?

The 47 million uninsured number is generated by an annual U.S. Census Bureau report. However, that report also states that the 47 million uninsured includes roughly 10 million illegal aliens without health insurance. Thus, if we subtract out the illegals, the number of uninsured American citizens without health insurance declines by more than roughly 37 million.

But is it accurate to assume that even 37 million Americans cannot afford health insurance? Absolutely NOT. Even Hillary Clinton during her presidential campaign once admitted that 25% of the uninsured could afford health insurance but chose not to purchase it. The Census Bureau reports that there are roughly 17 million people who make more than $50,000 per year and who, for whatever reason, decide not to carry health insurance.

In short, with two reasonable adjustments, the number of Americans who cannot afford health insurance has been reduced from 47 million to approximately 20 million.

But is the 20 million figure itself reasonably accurate? Probably not. Individuals moving between jobs lose their (employer provided) health insurance and when they do the Census Bureau counts them as "uninsured." Technically true. Yet during normal times, roughly half of these individuals will have re-acquired (in about 4 months) health insurance coverage with a new employer.

Finally, there are millions of adult Americans and children who have (nearly free) access to medical care benefits through Medicaid and other government programs who don't really need the direct cost of "insurance" and who don’t carry any.

Thus, with reasonable adjustments, there are in fact less than 10 million individuals who are so-called "chronically uninsured." (The Kaiser Family Foundation says the number could be as low as 8 million). These are individuals who have been unemployed for over 2 years and/or people from households that are too poor to afford non-employer health insurance premiums and who, for whatever reason, have limited access to taxpayer-supported health services.

So let’s grant that there are between 8 to 10 million Americans (total population: 307 million) who cannot afford health insurance and that this situation may require a marginal public policy adjustment. (Most states mandate expensive benefit coverage; curtailing those mandates would lower the cost of health insurance.) But whether that situation requires some massive, Washington D.C. health care reform – with new regulations and mandates on health care providers, insurance companies, and drug manufacturers – is entirely problematic.

Politicians and interest groups, eager to remake your medical world over to their liking, would do well to respect the Hippocratic oath administered to physicians: “First, do no harm.”


Excerpted from a small debate I was in elsewhere on the web:
...the stat you quoted (Obama and others) are 46-million uninsured. This number has been debunked by a few sources. Census date and other studies. 18.3 million of this number, for instance, are under 34 and voluntarily opt out of health care because they believe themselves to be young and healthy. BlueCross did a study that show in actuality only 8.2 million people are actually uninsured that want insurance but cannot pay for it. A number that Republican plans deal with by-the-by. But when you have no Republicans voting for a bill like this and 34 Democrats voting against it with Republicans, there is a unanimity (bipartisanship), just not the way Democrats wished to highlite. These numbers remind me of the stats used by Clinton and then later Kerry that said a woman makes 70-cents and 73-cents (respectively) to every man's dollar, or Michael Moore stating that 44-million Americans are illiterate -- Respectively: