The 'Real' Uninsured
June 24, 2009
Some critics say fewer people lack access to health coverage than official statistics make it appear. We break down the numbers.
Former Sen. Fred Thompson said on "Meet the Press" that "the 45 million ... figure of uninsured is probably about twice the real number of people who can't afford insurance or don't have access to it really." He's not the only one saying that the number is inflated. We find that many of the numbers cited are accurate, but may need to be seen in context to get a true picture.
Appearing on NBC's "Meet the Press" on Sunday, June 21, former presidential candidate Fred Thompson said that the number of the uninsured in the U.S. has been overstated: "The 45 million ... figure of uninsured is probably about twice the real number of people who can't afford insurance or don't have access to it really, who are not illegal aliens."
First we should note that the official Census figure for 2007 was actually 45.7 million. Thompson shaved off 700,000 uninsured persons by rounding down when he should have rounded up. And the figure for 2008 is likely to be higher, considering the millions who have lost their jobs and benefits since that figure was reported last August.
But what about his claim that illegal immigrants and middle-class earners who don't feel like buying insurance are swelling the ranks of the uninsured? That theme has been popular lately, appearing in articles and editorials from the National Review Institute and Investor's Business Daily, among others.
We've written before about the makeup of the uninsured, finding that according to the nonpartisan Kaiser Family Foundation, 79 percent are U.S. citizens, more than 80 percent are from families where at least one person holds a job, and two-thirds earn less than 200 percent of the federal poverty threshold – i.e., less than $42,406 for a family of four in 2007, the most recent year for which Census has figures for the uninsured. (KFF is a nonpartisan think tank that describes itself as "an evidence-based voice for people in the health system," especially the uninsured and "those most vulnerable and disadvantaged." It does not lobby for or against legislation.)
Claim: The Census numbers are overstated. This depends on what is meant by "uninsured." The Census Bureau's long-term Survey of Income and Program Participation found that 27.6 million people were without insurance for the entire year in 2005, and 65.9 million were uninsured for at least one month during the year.
The 45.7 million figure for 2007 comes from a different survey, the Current Population Survey. CPS asks about coverage during the previous year, but the Census states that the results are a better indication of the number of persons who were without insurance at any given moment during the year:
The SIPP survey, which asks the same group of people questions every four months, found that 45.2 million were uninsured in the month of December 2005, a point-in-time measurement that does indeed closely approximate the widely cited Census finding.
Claim: Many of the uninsured are not U.S. citizens. About 9.7 million of the uninsured are immigrants, both legal and illegal. The National Institute for Health Care Management Foundation estimates that 5.6 million of these are undocumented, but there are no hard data on that – NIHCM stresses that "the CPS does not collect information on legal status among non-citizens." Immigrants, especially new immigrants, are more likely to be uninsured than citizens. They are also less likely than citizens to use expensive emergency care, according to research from the Kaiser Family Foundation.
Claim: Many of the uninsured are young people who think they're invincible. The National Review Institute writes: "More than half of the uninsured are between 18 and 34 years of age, a group which has relatively few expensive health issues and for whom self-insuring (paying their own medical bills) makes sense." Actually, only about 40 percent of the uninsured are between 18 and 34, according to the Census.
Claim: Many of the uninsured already are eligible for public coverage. That's true – NIHCM found that in 2006, 12 million of the uninsured were eligible for Medicaid or the Children's Health Insurance Program (formerly SCHIP) but were not enrolled. These were disproportionately children – 6.1 million of the 12 million are under the age of 18, versus only 20 percent of the uninsured as a whole. NIHCM posits a number of possible explanations: People may be unaware of the programs or not know how to enroll in them; they may experience administrative hurdles to enrolling or staying in the program; or they may fear the stigma of public assistance. Some states also periodically institute CHIP enrollment caps, which may keep eligible people out of public programs. Utah, Georgia and Florida all had caps in 2007.
The uninsured still receive much less medical care and consume fewer medical resources than the insured. KFF found that those who were insured year-round incurred much greater health expenses than the full-year or part-year uninsured – $4,463 per person, versus $1,686 for the full-year uninsured and $2,983 for the part-year uninsured, $2,601 of which was incurred while they had insurance.
Kaminsky, Ross. "Why That 48 Million Uninsured Number is Wrong." National Review Institute Blog. 2 Apr 2009, accessed 23 Jun 2009.
"The Phantom Uninsured." Editorial. Investor's Business Daily. 16 Jun 2009, accessed 23 Jun 2009.
Kaiser Family Foundation. "The Uninsured: A Primer." Oct 2008.
Families USA. "Paying a Premium: The Added Cost of Care for the Uninsured." Jun 2005.
Families USA. "Hidden Health Tax: Americans Pay a Premium." May 2009.
Hadley, Jack et al. "Covering the Uninsured in 2008: A Detailed Examination of Current Costs and Sources of Payment, and Incremental Costs of Expanding Coverage." Kaiser Commission on Medicaid and the Uninsured. Aug 2008.
Institute of Medicine. America's Uninsured Crisis: Consequences for Health and Health Care. National Academies Press, 2009.
Cunningham, Peter and Samantha Artiga. "How Does Health Care Coverage and Access to Care for Immigrants Vary by Length of Time in the U.S.?" Kaiser Commission on Medicaid and the Uninsured. Jun 2009.
National Institute for Health Care Management Foundation. "Understanding the Uninsured: Tailoring Policy Solutions for Different Subpopulations." Apr 2008.
DeNavas-Walt, Carmen et al. "Income, Poverty, and Health Insurance Coverage in the United States: 2007." U.S. Census Bureau. Aug 2008.
"Yearly Premiums for Family Health Coverage Rise to $12,680 in 2008, Up 5 Percent, As Many Workers Also Face Higher Deductibles." Press release. Kaiser Family Foundation. 24 Sep 2008.
America's Health Insurance Plans Center for Policy and Research. "Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits."
Shen, Y.C. and S.K. Long. "What's Driving the Downward Trend in Employer-Sponsored Health Insurance?" Health Services Research, 41.6 (Dec 2006).
Kenney, Genevieve and Jennifer Pelletier. "Spotlight on Low-Income Uninsured Young Adults: Causes and Consequences." Kaiser Commission on Medicaid and the Uninsured. Sep 2008.
Smith, Vernon et al. "SCHIP Enrollment in June 2007: An Update on Current Enrollment and SCHIP Policy Directions." Kaiser Commission on Medicaid and the Uninsured. Jan 2008.
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