America's Uninsured

Former Bush White House economist Keith Hennesey walks his blog's readers through those "46 million American without health insurance."

1) There were 45.7 million uninsured people in the U.S. in 2007.
Of that amount, 6.4 million are the Medicaid undercount. These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly (intentionally or not) tell the Census taker that they are uninsured. There is disagreement about the size of the Medicaid undercount. This figure is based on a 2005 analysis from the Department of Health and Human Services.

2) Another 4.3 million are eligible for free or heavily subsidized government health insurance (again, either Medcaid or SCHIP), but have not yet signed up. While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room (or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care. There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.

3) Another 9.3 million are non-citizens. I cannot break that down into documented vs. undocumented citizens.

4) Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level. For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000. For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.

5) Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids.

6) The remaining 10.6 million do not fit into any of the above categories, so they are: U.S. citizens;with income below 300% of poverty;not on or eligible for a taxpayer-subsidized health insurance program;and not a childless adult between age 18 and 34.

As a policy matter, we care not about the total number of uninsured, but about the subset of that group that we think “deserves” taxpayer-subsidized health insurance. That is a judgment call that involves some value choices.