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By SEAN HIGGINS
INVESTOR'S BUSINESS DAILY | Posted Friday, June 26, 2009 4:30 PM PT
President Obama rarely misses a chance to stress that 46 million people in the U.S. lack health coverage. But the actual number of chronically uninsured Americans is far less, experts say.
Obama cited the figure in a recent speech to the American Medical Association to create a sense of urgency and moral necessity for his proposed health care reforms.
"We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens," Obama said.
The media and lawmakers, especially those advocating for broader federal coverage, often cite the 46 million figure — 45.7 million in 2007 according to the latest Census survey. But several studies have found that paints a distorted picture of the problem.
"This situation is really misrepresented," said June O'Neill, professor of finance at Baruch College, part of the City University of New York. O'Neill is also the former director of the nonpartisan Congressional Budget Office. "It is contradicted by the studies that show the large amount of resources that the uninsured actually do get."
Many can afford coverage but, for various reasons, choose to go without it, O'Neill says. Others are eligible for coverage from the government but don't take it. Others choose alternative means, such as neighborhood clinics.
Keith Hennessey, a top economic adviser to President Bush, breaks down the 45.7 million figure, based off of Census/Labor Department data. After excluding the well-off, young adults, noncitizens, those eligible for government programs and other factors, he finds there are just 10.6 million left.
Even that includes people who lacked coverage for a limited time.
The Census says people "were considered 'uninsured' if they were not covered by any type of health insurance at any time in that (past) year."
Thus, a person switching jobs who goes temporarily without coverage is deemed uninsured, even if he or she quickly gets coverage that same year.
"When you say 46 million Americans are uninsured that is a snapshot in time. It doesn't say anything about whether they were uninsured yesterday or whether they will be uninsured tomorrow," said Michael Tanner, health policy analyst at the free-market Cato Institute.
There are ways to address this issue, he says, such as making insurance more portable for workers.
Next, many people who can afford coverage on their own opt to go without to save money, other studies note. This is especially true of people in their 20s who as a group have the fewest health problems.
O'Neill did a recent study of people 18-64 who earn 250% of the poverty level — about $28,000 a year — or more. About 43% of those could afford coverage but went without it.
"Half of them are in the age group 18-34. These are people who are basically healthy. They may be in an accident but that's not enough for them to get coverage," O'Neill said. "The young are risk-takers."
A 2006 study by scholars at Johns Hopkins University and the Urban Institute argues that the number of people who have no insurance because they have no other option is closer to 24.9 million.
"We found that 24.7% of the uninsured are eligible for public health insurance programs. 55.7% are in the 'need assistance' category, and 19.6% are likely to be able to afford coverage on their own," the study's authors reported.
Even within the "need assistance" category, the authors didn't separate out people who lack coverage for a short time.
Many of those eligible for public programs may be unaware they are eligible. The authors called for more outreach.
Others may refuse to sign up, perhaps wanting to avoid the stigma of relying on a public program.
And some may be people who mistakenly tell researchers they are uninsured but actually are signed for Medicaid or SCHIP.
Co-author Lisa Dubay, an assistant professor at Johns Hopkins, who is working on an updated analysis, suspects the number of people who can't afford care has probably risen "because of what has happened with the economy and the job loss." She could not cite figures though, saying this was her "intuition."
Cato's Tanner also noted that the 45.7 million uninsured includes about 8 million to 10 million immigrants who may not be in the country legally and therefore are unlikely to be covered.
Ultimately, using the 45.7 million figure distorts the policy choices.
"It gives this implication that you have this huge pool of Americans who are never able to get insurance," Tanner said. "That inclines you towards much more government intervention than if you said we had a small pool of people who move in and out of the insurance market because they move in and out of the job market."
Congress this year expanded the COBRA health care program that lets people keep insurance after leaving their jobs, including subsidies for several months.
Lawmakers also have expanded the SCHIP health program for lower-income — and increasingly middle-income — children. That will boost the number of eligible Americans, though many already have private insurance.
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