Yes, Those Inflated Uninsured Numbers Really Are Inflated


Over at The New Republic, Anthony Wright strikes back against those of us (like me) who've cautioned against blindly accepting the 47-million-uninsured figure regularly tossed around by reform advocates. But in the course of doing so, it seems to me he very nearly makes the skeptic's case he's warning against. 

Wright begins by pointing out new Census data showing 46.5 million uninsured in 2008. He then notes that conservatives typically make a three-point case against the use of this statistic:

Critics make three arguments here: 1) the number includes immigrants; 2) the number includes people who are eligible but not enrolled for public health programs like Medicaid and SCHIP; and 3) the number includes people who make more than a certain income, and supposedly could "afford" coverage. 


In response to the first criticism he points to data showing that… there are more than one million illegals included in the uninsured count in California alone. That's 20 percent of California's uninsured population. Wright is almost certainly correct that the percentage is smaller nationally, but even if the percentage is, say, half that—10 percent—that still means that the 46.5 million uninsured number includes several million illegal immigrants—just as skeptics say. 

Next, Wright takes on the claim that a significant number of the uninsured are actually already eligible for government assistance through Medicaid or SCHIP. His response? "It's true that there are low-income family members who are eligible but not enrolled for an existing coverage programs." Yes, he also says that 1) there are still a large number of people who aren't eligible and 2) part of the reason that people who are eligible haven't signed up is that the forms are too complicated, and that health-care reform would simplify the process. 
Fair enough, but I don't see how this in any way proves the point made by skeptics wrong. Indeed, Peter Orszag, the administration's top health-care number cruncher, recently cited a report by the Kaiser Commission showing that, of the nation's 46 million uninsured, 11 million are already eligible for government assistance. 
Finally, he notes that, although there are indeed people who make $50,000, or even $75,000, a year who aren't insured, in some cases that's because health insurance is too expensive, and in other cases that's because they've been denied preexisting coverage. Again, true enough, but I'm not sure how this rebuts the original point that some significant number of the uninsured probably make enough money to purchase insurance but choose not to. Given that Census data indicates that nearly 18 million of the uninsured make more than $50,000 a year, and of that group, about 9.7 million make more than $75,000, it seems entirely reasonable to assume that several million people in the country could currently afford health insurance and simply choose not to purchase it. 
I'd add a fourth criticism as well, one that Wright also implicitly backs up: Not all of the uninsured are chronically uninsured. Instead, they're out of insurance for a day, or a week, or a few months (as I was earlier this year), typically when switching jobs. The fact that insurance is tied to employment certainly makes it more difficult for some of these people to get insurance, but to my mind, these individuals are not necessarily a sign that we're in crisis. Wright, on the other hand, thinks reform advocates ought to use the temporarily uninsured to expand the number of uninsured even further by including people who've been briefly uninsured over the last two years rather than one. 
That's because Wright's larger point is that it's better "not to think of the uninsured as a discrete population, one that can be marginalized," but instead "to think of uninsurance as a condition that can afflict anyone." Basically, he says, we should ignore the way the numbers actually break down and think of being without insurance as a wild predator that randomly attacks individuals for no reason whatsoever. 
Problem is, there are reasons people are uninsured—they don't bother signing up for assistance, they make too much money, they're in between jobs, etc. It's not random, and for many of those individuals, it may be possible to address the specific reasons rather force everyone into a one-size-fits-all mandatory insurance scheme. None of this is to deny that the current system is a terrible mess. But I do think the reform proposals floating through Washington right now will only make it messier.
More than that, it's perfectly reasonable to attack the inflated uninsured stat employed by reform advocates. Yes, millions of those people do have trouble getting insurance, and that shouldn't be ignored. But millions of them aren't chronically uninsured, do have options to get coverage, and don't really fit into the reformers' nation-in-crisis narrative. 
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