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Who Is Still Uninsured?

By August 7, 2014Commentary

An Urban Institute survey reveals what segments of the population remain uninsured after the first year of health reform.  (Urban Institute Survey)   According to the Institute’s survey, 13.9% of adults remain uninsured as of June 2014.  Compared with the total adult population without health coverage before the reform law enrollment period, those who are still uninsured afterwards were more likely to be Spanish speakers, unmarried and to have less than a high-school education.  They are more concentrated in the states that chose not to expand Medicaid, for obvious reasons.   About 37% are between the ages of 18 and 30 and another 42% are ages 31 to 49; reflecting the likelihood that younger, healthier people just don’t think they need health insurance.  Many of the still-uninsured are probably eligible for either Medicaid or subsidies in the public health insurance exchanges.   Only 17% say they have access to an employer-sponsored plan through either their own or a family member’s job.  While a substantial majority are aware of the exchanges and the individual mandate, there is a much lower awareness of the availability of subsidies.  About 60% give cost as a reason for not obtaining coverage, while 20% say they don’t want coverage or would rather pay the fine for not getting it.  It is likely that many of those who cite financial concerns as the basis for avoiding insurance are in fact eligible for Medicaid or subsidies and just aren’t aware of it, pointing to a clear educational and outreach opportunity.

The do-gooders who write these briefs act as though it is a tragedy that a large number of people still don’t have insurance and that everyone just has to get coverage.  This ignores both a respect for individual freedom and judgment that allows people to make decisions, which in some cases may actually be fairly well-informed and wise, that they don’t need or want health insurance, and the enormous cost that extending health care coverage is placing on public budgets and ultimately taxpayers.  Already many Americans have likely been bullied into buying coverage that will have little value to them and that they didn’t want.  This group will be even happier as they experience ongoing year-after-year growth in premiums and cost-sharing that is substantially higher than their growth in personal income.  And as all Americans who pay taxes become aware of the staggering costs reform is imposing on governments, there will more questioning about the value received.   I personally am hoping that a large number of Americans continue to defy the law and do what they think best for their personal situations.

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