The Uninsured and Under Insured

I decided to tackle the uninsured and under-insured before I started describing the Employee Sponsored Insurance (ESI)- even though ESI covers the largest number of citizens. I was driven to do this because there is so much disinformation on the internet with regards to the uninsured and under-insured.

On the internet, in responses to articles on the health care debate, there is a category of readers with an explicit or implicit bias that those without health care insurance are either illegal immigrants or people who are milking the system. Without a doubt, in any system there is an opportunity for fraud and the opportunity for fraud is not limited to those who cannot afford health care- in this instance, or to the rich (see Enron and any number of Wall Street villains).

So, what is the composition of the 47 million or so without health care insurance? Of necessity this has to be a statistical investigation.

The Current Population Survey (CPS) conducted by the Census Bureau and The Bureau of Labor Statistics is most often used and cited in investigations of the uninsured. The CPS survey is conducted monthly and has a sample size of about 50,000 households.
http://www.census.gov/cps/

Another source of data is the Medical Expenditure Panel Survey (MEPS), which is conducted annually on a smaller sample population, but is focused on households, employers and medical providers. The typical number of families surveyed is around 12,000.
http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp

Given that it is a statistical analysis, assumptions and conclusions around who the uninsured are, why they are uninsured along with what constitutes affordability for health insurance vary widely. I would recommend looking at conclusions from the Kaiser Family Foundation- "The Uninsured, a Primer" for a sympathetic view of the uninsured population (http://www.kff.org/uninsured/7451.cfm)

For a more hard-headed and analytical view of the uninsured read papers by Lisa Dubay et al from the John Hopkins Bloomberg School of Public Health. For example, see "The Uninsured and the affordability of Health Insurance Coverage"- http://www.healthaffairs.org/RWJ/Dubay2.pdf
Lisa Dubay uses data from the 2005 CPS and estimates that a quarter of the uninsured- approximately 11 million are eligible for public programs but are not enrolled. Another one fifth- approximately 9 million can afford health insurance but choose not to get it. The remainder need help in getting health insurance. It is ony at the end of the paper that she mentions that the individuals that she identifies can afford health insurance, may not have health insurance because their condition may make it unaffordable or unavailable.

I am sure the truth is somewhere in between. The issue is the extent to which higher projected numbers of the uninsured- implying higher program costs, may inhibit the passage of a health care insurance program.

My plan was to give a detailed description of the uninsured, however, watching the opposition to health care reform it has become obvious that this is not a battle over information. It is a battle over ideology- which no amount of data, logic or information can overcome.

For example, on the internet, you see unsubstantiated claims as to the number of illegal immigrants who would soak the citizenry in case there were a program to cover the uninsured. The various government surveys do not ask if a respondent is a legal or illegal immigrant. Hence claims around the number of illegal immigrants who would overwhelm the system are dubious at best.

The nation does need to wrestle with its conscience about the tension that exists between using the available means to control illegal immigration and providing affordable health insurance to those illegal immigrants who fall ill within our borders.