Critical Condition

Understanding the Uninsured

I’ve been pleased to see one theme in the current health-care debate that I didn’t expect: breaking down the uninsured population into its constituent elements, rather than assuming that all 46 million people categorized as “uninsured” by the Census Bureau are American citizens who lack access to health care for a long period of time. In truth, a large segment of this population is either in the country illegally, self-insured for small to medium-sized medical bills with savings and fairly high incomes, already insured by Medicaid or other government programs, or in between health-plan coverage for only a brief period due to changes in employment or location. It hasn’t been just the conservatives explaining these numbers better. That’s good.

Now, it’s time to update the discussion based on the latest info. Devon Herrick has just done so for the National Center for Policy Analysis. Here are the key points to remember:

* About 13.7 million uninsured adults and children live in households earning less than $25,000 annually. Many in this group already qualify for Medicaid or S-CHIP. For instance, past research by the BlueCross BlueShield Association estimated that up to 14 million uninsured individuals qualify for public coverage but have not enrolled. Indeed, three million to six million people identified as uninsured may already be covered by Medicaid or S-CHIP but erroneously told Census Bureau they were uninsured because they do not associate Medicaid with insurance coverage. This is referred to as the “Medicaid undercount.”

* Nearly 18 million of the uninsured lived in households with annual incomes above $50,000 – over half of them (9.7 million) in households with incomes that exceed $75,000 annually. There is considerable disagreement about the exact number of people in this group that may be able to afford health coverage. For instance, household income isn’t the same as family income. Unrelated individual living together may not pool resources the same way families would. Yet, it is increasingly common for couples to cohabitate in lieu of marriage and function as a family unit. Arguably, many in this group could afford some type of health insurance – possibly a high-deductible plan or a plan with limited benefits.

* Nearly 15 million uninsured residents live in households with incomes of $25,000 to $50,000 per year. This group does not qualify for Medicaid and (arguably) earns too little to easily afford expensive family plans costing more than $12,000 per year. These are precisely the people who would benefit from a uniform tax credit – which has been proposed as a way to cover the uninsured.

Plus this:

Immigrants. About 12.3 million foreign-born residents lack health coverage – accounting for 27 per­cent of the uninsured. In 2008, nearly 45 percent of foreign-born noncitizen residents were uninsured. Income may be a factor – but not the only one. A partial explanation for this disparity is that many immigrants come from cultures without a strong history of paying premiums for pri­vate health insurance. In addition, only immigrants who have been legal residents for more than five years qualify for public coverage.

John Hood is a syndicated columnist and the president of the John William Pope Foundation, a North Carolina–based grantmaker.

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