What is the Actual Number of Americans Without Health Insurance?

By Bonnie Erbe, Thomas Jefferson Street blog

CNN has a fascinating post today on a question I've pondered in this space in the past: How many Americans are truly uninsured? The number the Obama administration and Democrats have used for more than a year now ranges between 40 million and 46 million—at the upper end, that would be somewhere between 1 in 6 and 1 in 7 Americans.

A conservative think tank, the Pacific Research Institute, has been floating a much lower number, 8 million, claiming others who are uninsured are either temporarily uninsured (between jobs, perhaps) or earn enough to purchase health insurance but choose not to. Obviously, as a conservative group, PRI would promote figures that would tend to underestimate the need for healthcare reform, because the so-called government option gets government into the healthcare business, and most conservatives oppose big government.

CNN's so-called Truth Squad called PRI and found out that its figures were drawn from a 2003 study by the insurance company Blue Cross-Blue Shield:

That study concluded that a third of the uninsured—more than 14 million people—qualified for existing government programs such as Medicare and Medicaid, but were not enrolled in them. About another 13 million had incomes of $50,000 or more, suggesting they could obtain insurance on their own.

Nearly 6 million were what Blue Cross called "short-term uninsured," meaning people who are either between jobs or are just entering the work force. Many of the remainder were low-wage workers in firms with fewer than 10 workers, who could obtain coverage if the government offered tax credits for small businesses or grants to states, while others are illegal immigrants, it said.

There are two concerns that force one to question the value of the PRI figure:

1. Those 2003 figures are quite old at this point and do not take the recession into account.
2. Hypothesizing about what low-wage workers "could do" if tax laws were changed is a bit too "iffy" to count these people as insured for statistical purposed.

Citing that research and other census data, PRI President Sally Pipes argued in a widely circulated 2008 opinion piece that only 8 million people—just under 3 percent of the U.S. population—are "chronically uninsured."

Still, even the 46 million figure currently cited by Democrats has one major hole of its own. They rely on Census Bureau data:

But the Census Bureau's survey—which found about 15 percent of the U.S. population uninsured—is the largest and most regular survey, said Karyn Schwartz, a senior policy analyst at the nonprofit and nonpartisan Kaiser Family Foundation. And according to its findings, "The bulk of the uninsured are U.S. citizens, they're from working families, but they have low incomes and would likely have trouble affording private coverage," she said.

The latest Census Bureau survey was published in 2008, based on data gathered in 2007. That survey does not take into account effects of the current recession, which officially began in December 2007.

In my own limited and very anecdotal experience, I have encountered a handful of people whose personal income could indeed have made way for the purpose of purchasing health insurance coverage, but who chose not to. That's why different perspectives are helpful in this debate, if one weighs all the factors driving the differing perspectives.

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