One of the perpetual bones of contention in the ongoing health care reform debate is the precise number of people in serious need of help in this area. All too frequently we encounter various, exaggerated estimates, including some fact challenged quotes right here at TMV, which put the number as high as 50 million. Well, that’s certainly a troubling statistic for anyone to contemplate. In fact, the New York Times had a heartfelt opinion piece this weekend which recognizes a number of serious problems with the math on these figures, but then essentially bats them away, saying we shouldn’t dwell on the numbers.
But how many Americans are we really talking about here? And what mitigating factors need to be considered? A good place to start would be the most recent edition of the U.S. Census Bureau’s report on Income, Poverty and Health Insurance Coverage in the United States. (Follow the link, please, for the full PDF of the report.) It’s the same one cited in the Times piece. Turning to page 27 we find that the total number of people put in the category of not having health insurance during the previous year starts at 45.7 million (not fifty) which is down from 47 million in the previous reporting period. But that’s still a lot of people, isn’t it? We’ll need to do some more digging, obviously, and we will.
But first, here’s one more item which generally goes unmentioned when it comes to the Census Bureau’s Current Population Survey results, linked above. If you turn to appendix C, buried back on page 67, you will find that the Bureau doesn’t even have faith in its own numbers on this score.
National surveys and health insurance coverage
Health insurance coverage is likely to be underreported on the Current Population Survey (CPS). While underreporting affects most, if not all, surveys, underreporting of health insurance coverage in the Annual Social and Economic Supplement (ASEC) appears to be a larger problem than in other national surveys that ask about insurance. Some reasons for the disparity may include the fact that income, not health insurance, is the main focus of the ASEC questionnaire. In addition, the ASEC collects health insurance information by asking in February through April about the previous year’s coverage… Compared with other national surveys, the CPS estimate of the number of people without health insurance more closely approximates the number of people who are uninsured at a specific point in time during the year than the number of people uninsured for the entire year.
The report then refers you to the CBO’s report on How Many People are Uninsured and for How Long. This fascinating report informs us that, of the large numbers cited, roughly 45% of the people included in that statistic are not the chronically uninsured, but rather people who are in transition between jobs and are likely to have health insurance again within 120 days.
Next, we need to go back to the Census Bureau report and turn to page 31 where we are informed that their total number includes the category of those who are listed as “non-citizens” (which are carefully broken out from naturalized citizens vs. native born citizens.) The non-citizen rate of uninsured individuals clocked in at 43.8%, or roughly 9.4 million non-Americans. Since these people are not here legally and not paying into the system, that portion of the crisis is better addressed in a debate on immigration issues, but taxpaying Americans don’t need to be on the hook for that segment of the total.
While the number continues to drop, it’s also worth noting that we’re not talking exclusively about the abject poor who can’t afford insurance. As this Business and Media report informs us, that same Census Bureau summary includes the following:
But according to the same Census report, there are 8.3 million uninsured people who make between $50,000 and $74,999 per year and 8.74 million who make more than $75,000 a year. That’s roughly 17 million people who ought to be able to “afford” health insurance because they make substantially more than the median household income of $46,326.
Once you do some fairly basic math, you come up with the same figure that the Kaiser Family Foundation arrived at.
The liberal Kaiser Family Foundation puts the number of uninsured Americans who don’t qualify for government programs and make less than $50,000 a year between 8.2 million and 13.9 million.
Let’s say we take the high end figure and round up to 14 million. Yes, that’s still a lot of people in need of help, but the figure is becoming manageable at this point. If you look at the GOP’s health care bill, currently buried in Ways and Means, you realize that we could approve means testing for people in that category and issue them advancements and/or vouchers for five thousand dollars in coverage and you’d have accomplished the largest goal which most ObamaCare proponents claim to want to achieve. The price tag would not be chicken feed, coming in at 70 billion dollars, (and that figure assumes that every single person in that category would sign up) but after staring H.R. 3200 in the face at a cost of either 800 billion or two trillion (depending which CBO scoring method you go by) I can assure you that you’d have members from both parties doing back flips in their eagerness to sign on. And you could do it without driving a major American private industry into the ground and overloading public programs which we still don’t know how we’re going to finance in years to come.
Obviously there are other problems and they should be addressed as well. Those transitional people mentioned above should be able to move on to their next job without getting hit with preexisting condition clauses or major increases in premiums. Constantly increasing health care costs should be intelligently driven down, mostly by allowing interstate competition between private companies. But these are things where I believe the Republicans and Democrats can already find common ground. First, we’ll need to get the big issues put to bed, and a good place to start would be by being honest about how many people we need to insure and how we can most reasonably, efficiently and economically do it.
EDIT: Changed 60 billion to 70 billion in paragraph eleven.