There are 46 million uninsured people in the United States. To me, this is pretty much the beginning and end of the health care debate. When the greatest nation on earth cannot provide adequate health insurance coverage to a huge chunk of its population, something is very wrong. This needs to be addressed, in my view, and the sooner the better.
But not everyone agrees. And one of the most interesting developments of the health care debate is how those opposing reform have tried to rationalize why it’s OK to leave 46 million people out in the cold, so to speak.
The rationalizations are many. The uninsured are lazy; they qualify for public programs but don’t take advantage of them. Or, they’re young and healthy (and selfish) and they don’t think they need health insurance. Or, as one person charmingly put it, they’re “ILLEGALS.”
A recent editorial in the Washington Times entitled “Who Are the Uninsured?” summed up these arguments pretty thoroughly. It concluded that many of the uninsured qualify for Medicaid, some are illegal immigrants, and others are uninsured by choice. “The truly uninsured are, thus, largely young people who can afford insurance but who make the decision to temporarily go without it as they move between jobs.”
This is, to put it kindly, a distortion of the true picture.
Many people who are uninsured are young. “The lack of health insurance has become especially acute for young adults,” says a report on the uninsured by the New England Public Policy Center at the Federal Reserve Bank of Boston. “Over the past 25 years, the likelihood of being uninsured has more than doubled for 25- to 44-year-olds.” But contrary to the Times conclusion, the PPC report concludes that the rising number of uninsured is due in part to the fact that many of the uninsured have either lost or never had access to employer-sponsored health plans. “Between 2000 and 2005, the share of Americans covered by health insurance fell from 64 percent to 60 percent, representing a drop of 3 million people,” the report says. “Over the same period, the share of establishments, both public and private, offering coverage declined from 69 percent to 60 percent.”
I can tell you that the employer surveys I’ve seen since 2005 show that this trend has continued.
Dr. Rani Whitfield, writing for the Urban Thought Collective, puts it this way: “Young adults between the ages of nineteen and twenty-nine with low income and unstable jobs are the fastest growing population of the uninsured in America.”
That low-income part is important. The Kaiser Family Foundation, in its report, “Who are the Uninsured? A Consistent Profile Across National Surveys,” says that surveys consistently show that the majority of the uninsured are in fact employed, but more than half of the uninsured are in low-income families. Poor-paying jobs generally don’t offer health care, or offer plans with high deductibles and copays that may be unaffordable for the workers.
“More than half of the uninsured are in low-income families and about half are ethnic or racial minorities. The majority of uninsured adults are working, but their lack of education makes it more difficult for them to get jobs that offer employer-sponsored coverage.
“Those with low incomes (less than 200% of the poverty level; or $37,620 for a family of four in 2003) are less likely to have jobs that offer employer-sponsored coverage and are also less likely to be able to afford their share of the premium. Roughly a third of the nonelderly population comes from low-income families, but they are disproportionately represented among the uninsured because their chances of being uninsured are over three times greater than those with higher incomes,” the report finds.
And Factcheck.org has a nice summary of the issue, drawing on the KFF data:
“Ever since health coverage became a major issue in the 2008 presidential campaign, we've received periodic questions from readers who wonder whether a large percentage of the uninsured are non-citizens or illegal immigrants. They're not. According to the nonpartisan Kaiser Family Foundation, 79 percent of the uninsured are native or naturalized U.S. citizens. The remaining 21 percent accounts for both legal and illegal immigrants.
“What else can we say about the uninsured? More than 80 percent are from families in which at least one person works (70 percent from families where at least one person works full-time, and an additional 12 percent from families with a part-time worker). Two thirds are near or below the poverty line, making less than 200 percent of the federal poverty level. Only a small number (20 percent) are children, but nearly half are below the age of 30. Non-Hispanic whites make up two thirds of the population but less than half of the uninsured, and they are also more likely than any other race to have private insurance.
So there we have it, young, poor, and often minority people are more likely to be uninsured. Sounds like an important part of Obama’s coalition, no? Maybe that’s one reason he’s pushing health care reform.
Or maybe he just thinks 46 million uninsured in the United States is inexcusable.
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