NCPA - National Center for Policy Analysis

Uninsured by Choice

November 15, 2001

While there is concern that the number of Americans who lack private health insurance (and aren't enrolled in government health care programs) may rise in the near future, it actually fell about 600,000 to around 38.7 million in 2000.

There are number of factors that explain why so many people lack coverage -- affordability or lack of access alone cannot explain it. For example,

  • During the last decade, the ranks of the uninsured have increased among affluent households and decreased among low-income households (see figure).
  • Virtually all children from low-income families are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) -- yet the parents of about 7.7 million eligible children failed to enroll them.
  • The uninsured spent about the same portion of their income on recreation, alcohol and tobacco as the fully insured, but spent less than half as much on health care.

The poor have access to government programs but fail to use them, and almost one-third of the uninsured live in households with annual incomes above $50,000. So why are they uninsured? Age, health status and personal preferences may explain much.

According to Bureau of Labor Statistics research, 40 percent of the uninsured are young adults -- 15.2 million are between the ages of 18 and 34. And as noted above, 7.7 million children are eligible for SCHIP but aren't enrolled. Those two groups -- who are among the healthiest segments of the population -- together account for more than half of the uninsured.

Good health, personal consumption preferences and the availability of free charity care and emergency room care when needed are among the factors that lead many to stay uninsured by choice, say analysts.

Source: Devon Herrick (NCPA research manager), "Uninsured By Choice," Brief Analysis No. 379, November 15, 2001, NCPA.

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