Unlike most developed countries, the United States has a large percentage of citizens without health insurance, some for brief periods of time, many for extended stretches. Lack of insurance appears to lead to seeking and receiving less health care and potentially to worse health and greater health care costs in the long run. It is unclear, however, whether this relationship is just correlation or is truly causative. In any event, this perception that lack of insurance causes poorer health and higher costs was the rationale for the coverage expansion in the reform law. A regular CDC report looks at the characteristics of the uninsured. (CDC Article)
It should first be noted that the report is based on survey data, which has limits to its reliability. Those limits have not been explored as fully as they should be, given the importance placed on the data in public policy decision-making. What the surveys appear to reveal is that the number of uninsured persons for at least some period of time continued to increase into this year, rising from 56.4 million in 2008 to 59.2 million early in 2010. Over 80% were adults under the age of 65, when Medicare kicks in. The rest were children, and this number has declined as a result of SCHIPs expansions.
About two-fifths of the adults were without coverage for only part of the year, which could be as short as one day. In 2009, about 12 million adults under 65 who had household incomes under the federal poverty level of about $22,000 were without coverage at least part of the year. These persons are all likely eligible for Medicaid, but just didn’t enroll. They should not be considered uninsured, because they clearly have basically free access to insurance but chose not to enroll. On the other end of the spectrum, there were almost 7 million such persons with household incomes over $88,000 who were uninsured part of the year. These people almost certainly could afford some kind of health insurance and again, apparently are choosing not to purchase it. A lot more work on why people who clearly could enroll in an insurance plan don’t would be very useful and might lead to better public policy.