Number of Uninsured may be overstated

The Kaiser Family Foundation’s State Health Facts website gives a wide variety of statistics detailing health insurance in America. The study finds that there are 45.5 million uninsured non-elderly individuals (16% of the total non-elderly population). Out of this total 4.1 million (9% of the uninsured) are poor children and 12.6 million (28% of the uninsured) are poor adults.

While these numbers are large, they may be overstated. The 1997 Balance Budget Act created the State Children’s Health Insurance Plan by which states were required to offer insurance to all children in poor households. Thus, the balance of the 4.1 million children must be composed of a) illegal immigrants, b) children in households where their parents decided not to sign them up for SCHIP or c) poor bureaucratic implementation of the progam in certain states.

Also, the 12.6 million figure for poor adults may be overstated as well. While these individuals may not have insurance, many poor individuals who undergo hospital procedures are signed up for Medicaid at the hospital. Thus, although these individuals are technically uninsured, in reality they do have access to health insurance. All poor adults are not eligible for Medicaid, however. Most single males between the ages of 18 and 65 who are do not qualify for Social Security Disability also do not qualify for Medicaid.
The extent to which these figures are overestimated, however, is difficult to calculate.

The State Health Facts numbers come from the Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau’s March 2004 and 2005 Current Population Survey (CPS: Annual Social and Economic Supplements)

1 Comment

  1. Uninsured estimates are just that- estimates.

    reasons for incomplete coverage of children:
    1. S-CHIP was not required to cover “all children” in all “poor households”: S-CHIP eligibility set at 200% FPL, but beyond that, varies with state, therefore:
    -“bureaucratic implementation” varies by state: enrollment requirementes, education efforts, and the states, facing budget problems combined w/ decreasing federal payments, have had to cut back on S-CHIP enrollment and returned money to the feds
    …creating many barriers to take-up. So, a combination of parents deciding not to sign up as well as not knowing about the program at all.
    2.Estimated illegal immigrants change eligibility estimates 3-5% at most, but certainly, this is hard to measure
    *for more info on changes in S-CHIP coverage from 1996-2001, see Cunningham, et al in Health Affairs, 2003.
    *for info on the financial troubles of S-CHIP, many articles abound as early as 2001:

    As for adults:
    Qualifying for Medicaid as an adult following inpatient admission hardly counts as “access to health insurance.” More like, access to some catastrophic coverage. The uninsured who qualify at this point have not had access to coverage for primary care or ambulatory care in general. As you pointed out, many will still not qualify for Medicaid- not just single males, but many adults w/o dependent children who do not have a disabling or terminal condition.

    Note that often these estimates of the uninsured are those who are uninsured for 12 months or more- this does not include a substantial population cycling through uninsurance, private and public insurance. Those on the margins can have nearly comparable limited access to care and poorer health status.

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