NCPA - National Center for Policy Analysis


November 24, 2008

Next year, when Barack Obama becomes president, he will almost certainly move quickly toward some form of government-provided -- and possibly government-mandated -- health insurance.  A principal reason for this is the oft-cited figure of 46 million uninsured Americans.

But what does this number mean?  And do we really need to remake our entire health-care system to protect the uninsured?  Most people have an incomplete understanding of the uninsured population, which can lead to bad policy choices, says William Snyder, a policy adviser to the Heartland Institute.

Many Americans believe that the uninsured are too poor to purchase coverage and that government programs aren't available to them.  However:

  • According to a study published in Health Affairs in November 2006, some 25 percent of the uninsured were in fact eligible for public coverage, and another 20 percent probably could afford coverage on their own.
  • If we apply those percentages to today's uninsured population, roughly 25 million people would need assistance in order to get health insurance.

That's a major concern, but the notion that there are 46 million Americans who can't get the health care they need for lack of money or public assistance is a myth, says Snyder.

The other two common misperceptions are that the uninsured don't get health care, and that when they do they're "free riders," i.e., they don't pay for the care they get, explains Snyder:

  • A study published by the California HealthCare Foundation (CHCF) in April 2000 found that, of the uninsured California residents whose household income was at least twice the poverty level, 50 percent (about 1.3 million) had received care in the last year for which they were charged, and another 8 percent had received care for which they weren't charged.
  • The study also found that 89 percent of these people were either somewhat or very satisfied with the care they received, and that only 15 percent went to the emergency room versus a doctor's office or clinic when they got sick.
  • Another recent study, published in Health Affairs in August, had similar findings, and estimated that uninsured Americans will receive $86 billion worth of health care in 2008.

These two studies also provide evidence that disputes the free-rider myth:

  • The CHCF study found that of the 1.3 million uninsured who received care for which they were charged, 80 percent had paid for it, and almost half of the remaining 20 percent were paying in installments.
  • The study published in Health Affairs estimated that the uninsured would pay for $30 billion of their health-care costs this year -- more than one-third -- out of pocket.

Source: William Snyder, "What Do We Really Know About the Uninsured?  We should find out before Obama turns our health care upside-down," Wall Street Journal, November 21, 2008.

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