During his interview with CBS news anchor Katie Couric on Sunday, President Obama said he wants to "make sure that the 30 million people who don't have health insurance can get it." Obama and his underlings have been using that figure since last fall at least. It corresponds, conveniently enough, to the number of people the Congressional Budget Office estimates would obtain coverage under the Senate health care bill. But it is about one-third smaller than the 46 million people in the United States who, according to Census Bureau survey data, lacked health insurance at some point in 2008. OMB Director Peter Orszag explains the discrepancy this way:
The Census report indicates that of the 46 million uninsured individuals, 34 million were native born and 2.8 million were naturalized citizens. The report thus shows that there were 36.8 million uninsured U.S. citizens (native born and naturalized) in 2008. An alternative calculation includes legal immigrants, which based on a figure from the Pew Hispanic Center would bring the total to something like 39 million.
The administration's number, then, is designed to exclude noncitizens, presumably to emphasize that they are not eligible for the subsidies that would be provided by the Senate or House health care bills (although Republicans have argued that they would nevertheless be able to obtain them). As Orszag notes, limiting the count to citizens yields an estimate of about 37 million, and the president often refers to "more than 30 million American citizens who cannot get coverage."
But it is not true that all 37 million "cannot get coverage." More than one-fifth of the uninsured have annual household incomes of $50,000 or more, and another quarter or so are either already covered by existing government programs (but misreported their status) or could be (but failed to apply). Most of the uninsured are 18-to-34-year-olds, many of whom may decide to go without medical coverage because they think that, being young and healthy, they won't need it. Obama's individual insurance mandate—which would require such people to purchase coverage they don't want so they can subsidize care for older, sicker policyholders—implicitly concedes that many Americans lack insurance not because they "cannot get coverage" but because they choose not to get it. The number of Americans who lack insurance because they cannot obtain it is surely substantially smaller than Obama says it is—an important point to keep in mind as he continues to insist that covering "30 million people" is a minimum requirement for health care reform.