The reform law created such a wonderful health insurance market, just guaranteed to get all those uninsured people into a health plan, so it is really hard to understand why the results are so underwhelming. Aside from the Medicaid expansion, scarcely a dent was made in the uninsured population. An Agency for Healthcare Research and Quality Statistical Brief may go a long way toward explaining why. (AHRQ Brief) The brief is based on survey results from the MEPS in time periods over 2001 to 2011. In 2011, 12.1% of adults over 18 agreed with the statement that “I’m healthy enough that I really don’t need health insurance.” This compares to 11% in 2006 and 9% in 2001. And if the Medicare-eligible seniors are taken out of the sample, in 2011 the figure is 13.4%. (Not clear to me why you would include seniors in the sample when they all automatically have health insurance through Medicare.) An even higher number, 24.3%, in 2011 agree that “Health insurance is not worth the money it costs”, compared to 21.8% in 2001, and again, if restricted to the non-Medicare population, the figure rises to 26.3% in 2011. I am guessing agreement with both those statements has risen by 2014. More interesting, however, is the persistence of these feelings by the same people. About half the respondents who thought they were too healthy for insurance or that insurance was too expensive in 2010 continued to feel that way in 2011. This suggests a substantial volatility in people’s’ perception, which may relate to intervening life or insurance status changes, or a health need.
As might be expected, adults under 45 are more likely to think they don’t need health coverage and that it is not worth the premiums. Hispanics and men were also subgroups with higher agreement rates with these two statements. People with lower education had higher rates of feeling healthy and not needing insurance, while the higher income group agreed more both with that statement and that insurance wasn’t worth the cost. Those in the 18 to 65 age range who were uninsured for all of 2011 had a much higher agreement rate that they were too healthy to need insurance, 21.5%, and 36.7% said health insurance wasn’t worth the cost. So within the target group for the reform law, the uninsured, a large minority doesn’t think they need health coverage or that it is worth the money. This likely explains why so few signed up. But overall, the survey suggests that most Americans recognize a value in health insurance, but many are concerned about the cost. The one-size fits all reform law solution doesn’t address this at all and its misguided embodiment of “fairness” penalizes younger, healthier adults who might be happy to purchase a bare-b0nes, catastrophic policy, but can’t do so.