NCPA - National Center for Policy Analysis


September 11, 2009

One of the primary goals of health reform is to ensure that all Americans have health insurance.  Yet it is generally overlooked that the proportion of Americans without health coverage has been relatively stable over time, says Devon Herrick, a senior fellow with the National Center for Policy Analysis.

According to the Census Bureau, in 2008 the number of individuals in the United States lacking health coverage rose from 45.7 million to 46.3 million.  The proportion of uninsured Americans remained virtually unchanged, rising from 15.3 percent to 15.4 percent.

In fact, the proportion of people without health insurance in 2008 is virtually unchanged from a decade earlier.  The increase in the number of uninsured over the past decade is largely due to immigration and population growth -- and to individual choice, says Herrick.

How big is the problem?  In 2008, according to Census Bureau data:

  • Nearly 85 percent of U.S. residents (255.1 million people) were privately insured or enrolled in a government health program, such as Medicare, Medicaid or the State Children's Health Insurance Programs (S-CHIP).
  • About 13.7 million uninsured adults and children live in households earning less than $25,000 annually. Many in this group already qualify for Medicaid or S-CHIP; for instance, past research by the BlueCross BlueShield Association estimated that up to 14 million uninsured individuals qualify for public coverage but have not enrolled.
  • Indeed, three million to six million people identified as uninsured may already be covered by Medicaid or S-CHIP but erroneously told Census Bureau they were uninsured because they do not associate Medicaid with insurance coverage; this is referred to as the "Medicaid undercount."
  • Nearly 18 million of the uninsured lived in households with annual incomes above $50,000 -- over half of them (9.7 million) in households with incomes that exceed $75,000 annually.
  • Nearly 15 million uninsured residents live in households with incomes of $25,000 to $50,000 per year; this group does not qualify for Medicaid and (arguably) earns too little to easily afford expensive family plans costing more than $12,000 per year.

How Serious Is the Problem? 

  • During the past 10 years the number of people with health coverage rose nearly 24 million, while the number without health coverage only increased about 3.75 million.
  • Both increases are largely due to population growth; typically, those who lack insurance are uninsured for only a short period of time -- more than half will have coverage within a year.

Although the proportion of people without insurance coverage has changed little in recent years, much can be done to reduce the number of uninsured, says Herrick.  This could include a uniform tax credit like the one that has been proposed in the Patients' Choice Act of 2009, sponsored by Senator Tom Coburn and Representative Paul Ryan.

Source: Devon Herrick, National Center for Policy Analysis, Brief Analysis No. 676, September 10, 2009.

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