Just who are the uninsured?

As the debate over the proposed new government health plan
continues to percolate, we hear much banter about the urgency and
moral imperative to cover the 45.6 million of the U.S. population
without medical insurance. Amidst that political rhetoric, no-one
is addressing the logical question that follows.
Just who are the uninsured?
There are many different demographics that could be used to
characterize the uninsured. Economic status and citizen status are
two which are covered in this discussion.
According to the U.S. Census and a 2008 report published by
NIMCH (National Institute for Health Care Management), the economic
makeup of the 45.6 million uninsured (15.8 percent of the U.S.
population) is as shown in the following table:
The full NIHCM report link is http://www.nihcm.org/pdf/NIHCM-Uninsured-Final.pdf.
As shown above, 12M (4.1 percent of population) are already
eligible for public programs but have neglected to enroll. In the
moderate to higher income categories ($42,300 to over $82,600),
20.1M (6.8% percent of population) deliberately choose to be
uninsured for various personal reasons even though their income is
(2) to over (4) times the FPL (federal poverty level.)
Finally, 14.4M (4.9 percent of population) have incomes less
than $42,300 (below (2) times the FPL). If the focus of our claimed
health care crisis is to assist the truly needy, then we should
structure a plan to address that 4.9 percent of the population. The
vast majority (95.1 percent) is either already insured (84.2
percent), eligible for public programs but failed to enroll (4.1
percent) or has an income of $42,300 to over $82,600 and has chosen
not to be insured (6.8 percent).
So why is it necessary to completely overhaul the present health
care system incurring a staggering increase in budgetary costs and
trillions of dollars of debt for our future generations? A program
aimed at assisting the 4.9 percent who are ostensibly the truly
needy would make far more moral, fiscal and common sense.
While we are examining the statistics, it is worthwhile to
dispel the popular myth that illegal non-citizens are a large
uninsured segment. That percentage of the population is not
inconsequential but is lower than claimed by many.
The 10M uninsured non-citizens are 3.4 percent of the
population. Of that segment, 1.9 percent are illegals while the
other 1.5 percent are in the U.S. on a visa, work permit or some
other legal basis. Those 10M are part of the 46.5M total already
noted and likely included in the lower income category.
Obviously, this is not an exhaustive treatment of the
demographic makeup of the uninsured. Age is also a factor. For
example, 31 percent of adults in the 19-29 age category are
uninsured. They comprise 29 percent of the total uninsured. This
category includes college students, low income adults and adults
who work for small companies not providing health insurance. About
85 percent are self-reported to be in good health. As a result,
they choose to save the cost of health insurance which they may or
may not be able to afford.
It is clear from the above numbers that citing an uninsured
total of 46.5 million without qualifying the makeup of that total
is completely misleading. Before we rush headlong into a total
overhaul of our health care system, we should critically examine
the makeup of the uninsured and tailor a plan which addresses the
truly needy. It should not be necessary to eliminate insurance
choices for the 84.2 percent who are insured while 4.1 percent who
qualify for aid fail to enroll and another 6.8 percent with
moderate to high incomes choose to be uninsured.
A targeted plan to assist the 4.9 percent truly needy is a
fiscally responsible and common sense approach to health care
reform.
Mel Amato is a Healdsburg resident.