The Centers for Disease Control conducts the National Health Interview Survey program. Among other things, it asks about insurance status and is a primary source for information on type and prevalence of insurance coverage. In the wake of the reform law and opening of the health insurance exchanges, a lot of numbers have been thrown about on the impact on the number of uninsured Americans. Reducing that number was supposedly the primary motivator behind the reform law. The CDC issued an analysis of interviews conducted with about 27,600 Americans regarding their insurance status in early 2014. (CDC Report) During the first three months of 2014, 41 million Americans, or 13.1% of the population, continue to lack insurance coverage at the time of the interview; while 55.5 million or 17.8% said they were uninsured during at least part of the year prior to the interview and 29.9 million or 9.6% had been uninsured for longer than a year prior. About 166 million of people under age 65 were covered by private insurance, of whom 1.4% or 3.7 million, got their coverage on one of the exchanges. (note that this number is substantially lower than the inflated one the Administration has been broadcasting) Of adults aged 18-64, 18.4% were uninsured when interviewed, 17% had public (i.e. Medicaid or Medicare) coverage and 66% had private health insurance.
Looking at the key age groups targeted for coverage expansion, for those aged 19-25, the percent uninsured at time of interview dropped from 26.5% in 2013 to 21% in the first quarter of 2014. For all adults aged 18-64, however, the decreased a more modest 2%, from 20.4% in 2013 to 18.4% in 2014. It is simplistic to think that it would be best if everyone had health insurance and that if they did, health status and health outcomes would be much better. The evidence doesn’t support that and in a free country people should be allowed to make their own choices about what products and services they buy, as long as they bear the full consequences of those choices. While it may be viewed as a good thing that the reform law appears to be reducing uninsurance, what have the costs of that minimal private and much larger public coverage expansion been? At a minimum, tens of billions of dollars just in administrative expense to create exchanges and desperately try to persuade individuals to use them. More lastingly, a huge increase in public spending, taxes and debt burden, which hurts every citizen. Still hard to believe there isn’t a better, more just alternative.