Who Are the Uninsured?

We always talk about the 47 million or so people that do not have any type of health insurance in very sterile, non-real way. And I feel that many comments that are made come with certain implications – mainly that these people are poor, lazy, irresponsible, and somehow responsible for their lack of insurance. I know some are screaming, “But even if they are all of those things they still should be taken care of?” Maybe, but that is not my point here. Some might want to pipe in, “Yeah, I know a few and by providing this free care we are all being enablers.” Again, not my point here, but both sides should feel free to discuss below. However, before you do let’s take a closer look at who the uninsured are, and maybe equally importantly, what the trends are telling us.

In 2005 46.1 million Americans under the age of 65 were uninsured. Eight in ten come from working families. Seven in ten come from families in which one or more people work full-time. The poor (under the poverty level) and the near poor (under 200% of the poverty level) have a higher rate of being uninsured, 36% and 30% respectively. Most of the people in this bracket who are insured receive Medicaid or SCHIP (and count as insured). These two categories cover two-thirds of the uninsured. 80% of the uninsured are US citizens (KFF).

Maybe more striking, in 2006 another 1.3 million working adults loss their insurance and 1.2 million of those worked full-time. More surprisingly, those making $25,000- $50,000 saw large increases in the number of uninsured. And get this…1.4 million people who live in families making over $75,000 loss their insurance (Commonwealth Fund).

There are many reasons for the rising number of uninsured (and most intertwine), but to make it simple I will just list a few: rising health care costs (duh), change in workforce from manufacturing to service industries, a downward shift in percentage of workforce from large companies to small companies, and international pressures (using Friedman’s term a “flat” world).

So for those of you who are comfortable with their insurance status – watch out! Unless something changes a greater percent of the middle-class, and even, daresay, the upper middle class may be swallowed by the rising tide of the uninsured.

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5 responses to “Who Are the Uninsured?

  1. That’s interesting information. Can you tell us how many uninsureds we would have if we subtracted:

    — Undocumented aliens.

    — Those covered by Medicaid and SCHIP (they’re insured; they just don’t pay premiums).

    — Those who can afford insurance (can we say anything above “near poor”?) but have chosen not to buy it.

    Until these folks are deleted from the stats, I can’t appreciated the extent of the uninsured “problem” in the US.

  2. Bob,

    I will look at this in more depth, but a quick search revealed the following:

    I googled the numbers and got a few blogs with out of this world stats. My numbers come from respected health care foundations – Commonwealth Fund and the Kaiser Family Foundation.

    Data on undocumented aliens will be difficult to find because they are undocumented. I’m not an expert on this, but I feel that estimates of undocumented aliens in the country always seem to be wide. But the number of illegal aliens is under 20%. We know that 80% are US citizens and 15% have 5 plus years of residency under their belt, meaning that there is a greater chance that they have some sort of legal status, but who knows. I don’t.

    Mediciad and SCHIP are considered insured so they won’t factor into the .

    I’m not sure about your third group, but my insights are this. The majority of this group are the twenty-somethings who weigh their typical health care costs (which are minimal) and the costs of health insurance and decide not to buy. It’s not in their economical interest and many of them in “starter” jobs don’t have employer insurance. This group accounts for 13.3 million people, but only 28% make more than 200% of the poverty level. That’s 3.6 million who probably could afford insurance, but decide not to because the premiums are deemed too high for their typical costs.

    So in conclusion (these numbers will be a good guess) we have about 3-4 million illegal immigrants and 3-4 million who probably could afford it, but don’t buy it because it doesn’t make sense for them. Again this is extremely rough, but that leaves the number of uninsured for other reason somewhere in the 30 millions.

    One note about the twenty-somethings. It is in your interest if they get insurance. Their participation will lower your costs so any policy that compels them to join will be good for all.

  3. Thanks for the clarification, lpaul. I confess to knowing very little about eligibility for Medicaid and SCHIP but given your statement that only 36% and 30% of the poor and near-poor respectively are covered, could it be that the remainder are, in fact, eligible but choosing not to sign up? If not, why not? (Maybe some percentage are illegal aliens???)

    As for your claim about the number of illegal aliens, I had come across an estimate (can’t remember the source so feel free to disregard) that 2/3 of illegals are uninsured. If there are 12 million illegal aliens (the most commonly reported number I’ve encountered), that would put the number of uninsured illegals at eight million. Your estimate, 3-4 million, would suggest that 2/3 to 3/4 of illegals are insured which doesn’t sound plausible to me based on the nature of employment that characterizes most in this group.

  4. Regarding your first question about Medicaid and SCHIP. Many are eligible and are not signed up. You are right. The reason: It is complicated business(social workers out there chime in). The enrollment, the re-enrollment, financial criteria, etc is tough for many people especially relatively un-educated people. Factor in mental illness, unstable lives, etc. Any program that is not “automatic” is going to have less than satisfactory enrollment rates. What do I mean by that. Medicare is “automatic” once you turn 65. You are don’t really have to qualify. As long as you worked a certain amount of quarters and are over 65 you get Medicare. It’s enrollment rate is high. Medicaid depends on a lot of eligibility requirements. The details of the program are beyond my understanding.

    An example:
    I have very bright and put-together friends and because of tragic circumstances their child is on Medicaid. They spend hours a week keeping up with it. Hours while also taking care of a very sick child. Simply stated – It’s ridiculous.

    To get more clarification on the illegal alien issue I went to the U.S Census Bureau. The uninsured rate for the native born population is now 13.2% in 2006 up from 12.8% in 2005. The uninsured rate for foreign born was unchanged, but stands at 33.8%. Among the foreign born the uninsured rate of naturalized citizens is unchanged at 16.4% (close to the native born rate) while the uninsured rate for the non-citizens (legal or illegal I’m not sure) rose from 43.1% to 45% in 2006. The total number of people that the U.S Census Bureau used in this particular study for non-citizens is 9.4 million. Roughly half are uninsured so we are looking at a rough estimate of 4.5-5 million people. Now this number may be larger because I have to think that counting illegal aliens is a tough thing to do and that most of the people that are not counted do not have insurance, but at the same time those that are not counted will not take away from the 47 million uninsured number (The 47 million number comes from the U.S. Census Bureau). Meaning the number of legal residents who are uninsured is just about 40 million. I think this math makes sense.

    I think this is an interesting exercise, but my motivation on this topic does not stems from illegal aliens and their plight nor does any reservation I have toward reform policies stem from illegal aliens and their illegal actions crossing our borders. This issue is not a big deal for me. They are people and they should be treated with a certain level of respect and compassion, but the question of whether they should benefit from a universal health care system is not where my passion lies. However, I realize that for some people this is a huge stumbling block and for that reason it needs to be addressed.

  5. Thanks, lpaul. My issue with illegal aliens’ eligibility for health care (whether it be treatment at no cost in the ER, for which they’re entitled today, or coverage under some form of UHC in the future) is that it represents an sizable increase (almost 20%, if populations correlate with expenses) to the cost that will be loaded onto taxpayers’ shoulders. I don’t think these folks are any more deserving of free medical care, courtesy of American taxpayers, than the millions of other indigent people who remained in Mexico and Central America (perhaps they’re less deserving in that they violated our immigration laws).

    Regarding the lack of participation of the indigent in Medicaid, I would guess that the contrast in participation between Medicare and Medicaid may also reflect differences in characteristics between the two groups. All other things being equal, one would expect that the poor would be less intelligent and more irresponsible than the general population (boy, that statement will undoubtedly generate some hate mail!). But if that’s the case, all the more reason that government officials should make the program sufficiently user friendly that it actually gets used. If a government single-payer UHC program is put in place by the same ninnies that designed Medicaid, we’ll still be wondering why so many of the indigent lack health care even after rolling out the new program.

    In any case, removal of both these counts (i.e., illegal aliens and those eligible for Medicaid but not participating) drops the number of uninsured that people point to when characterizing the need for comprehensive reform. Wouldn’t you want to pick the low hanging fruit first in dealing with accessibility to health care? Indigent folks treated at the ER who can’t document their right to be in the US should be deported, an immediate reduction in health care expenses and an improvement in affordability. Medicaid enrollment would be simplified to ensure that all those who are eligible are, in fact, enrolled. After you’ve done that, plus eliminating those who voluntarily choose not to insure but are financially able to, what’s the final number that we can call the nut of the uninsured problem?

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