THE MAIN POINT - People without Health Insurance
National Health Information Survey - NHIS- 2005
There are not 47 million who want but who cannot get health insurance. Neither the CDC's National Health Interview Survey (NHIS) nor the Census Bureau's Current Population Survey (CPS) support this claim.
The number of people without health insurance is not the same as the number of people who are unable to get insurance.
The number of people without health insurance reported by the major surveys includes EVERYONE who does not have health insurance - and everyone includes millions of people who could get but have CHOSEN not to buy health insurance or who are unaware of government programs AND all of their children.
The surveys do not report how many people want but cannot get insurance. That number must be estimated from their reported numbers and other available statistics.
To estimate the number of people unable to get health insurance, one has to remove wealthy people who don't want it, young adults who decide they do not need it, people temporarily in between jobs who decide not to buy insurance before a new job, and all those who are unaware of government programs that they could use.
Our estimates indicate that the number of people who want health insurance but are unable to get it is less than half the over 40 million in the surveys. The true number of people who cannot get health insurance is probably in the 20's of millions or even less.
For a full discussion and details on how we performed this estimation, see the People withouth Health Insurance Model.
The reason why we believe that the true number of people who want but cannot get health insurance is smaller is based estimates we have made from numbers in this survey summary and others. They are not directly available. Here are numbers consistent with our assertion.
- # uninsured between 18-30: 12.8 million (31% of uninsured).
- # uninsured for less than one year: 9.1 million (21.9% of uninsured).
- # uninsured with good - excellent health: 37.7 million (90.5% of uninsured).
These numbers suggest that a large fraction of the uninsured are dominated by people with some combination of being: in between jobs, young, and quite healthy. These are people who could, if they chose, acquire health insurance.
Nonetheless, there are still a lot of people who probably have difficulty getting insurance. The number is just not over 40 million people.
Read more below to understand how to interpret the data.
Sources of the Data
Tables 1-7 come from the National Health Information Survey (NHIS) for the year 2005 prepared by the Centers for Disease Control (CDC). We will add the 2006 soon but do not expect the new numbers to affect our interpreration. The total uninsured reported for 2006 is 43.6 million and for 2005 is 41.6 million. The number of uninsured from a survey conducted from January through June 2007 is 42.5 million.
There is another study performed by the Bureau of the Census which we have also summarized. Both of these studies are surveys not censuses and are subject to sampling error and error in method.
Questions Answered - Not Answered by the Numbers
The uninsured numbers in the following NHIS tables answer the following question: "How many people are uninsured at a given point in time for ANY reason?
The numbers DO NOT answer the question, "How many people are uninsured and want but cannot get health insurance."
Neither survey answers the first question. In fact, the NHIS survey includes
- wealthy people,
- young adults,
- people temporarily without insurance,
- people who could get insurance from the government but are not aware they can,and of course,
- people who cannot get insurance who want it, AND
- the children of ALL of the above.
As you have seen from the numbers, there are a large numbers of young adults and people who have been without insurance for less than a year. Almost all of the uninsured are healthy. We are trying to estimate the number of people who cannot get insurance and believe that number to be between 25% and 50% of the 41.6 million in our tables or between 10 and 20 million people.
The Census Bureau Numbers Answer Very Different Question
The Census' Current Population Survey (CPS) which reports 44.8 million uninsured in 2005 and 47.0 million uninsured in 2006) answer the question, "How many people have been uninsured for any reason AND uninsured for the entire previous year?"
These numbers would therefore not include the NHIS component of people insured for less than one year (about 9.1 million), yet the Census number is bigger, 44.8 million compared to 41.6 million. One would expect that the CPS should be smaller since it is not supposed to include people uninsured for less than one year and the NHIS does.
Removing the 9.1 million who have been uninsured for less than 1 year from the NHIS to make the numbers more comparable leads to 44.8 (CPS) vs. 32.5 (NHIS), i.e. there is a very large discrepancy between these two surveys for 2005. These discepancies persist in 2006, 47.0 (Census) vs. 30.7 (NHIS).
This disrepancy has not gone unnoticed by the government agencies that publish the numbers. (See References). Some analyses claim that respondents to the CPS may be unable to recall how long they have been uninsured and not answer correctly. We question whether this is a full explanation. Certainly, people might forget if they have been uninsured for 11 vs. 12 months but are less likely to confuse 1 month with 12 months.
We think that there must be a difference in methodology or sampling that is leading to this difference but cannot be sure. Whatever the reason, it is certainly a questionable practice of choosing one number over the other when it is clear that at least two serious attempts have come up with very different numbers. For your interest, there are other estimates which we have not reported.
Uninsured Illegal Aliens
In the NHIS survey report, we see NO mention of illegal aliens. The surveyors have not attempted to include or exclude this group and we know of no way to estimate whether there is a fair sample of them in this survey.
Table 1. People under 65 years of Age
We include this table of TOTAL people so that readers can easily compute fractions and percentages.
Table 2. People by Type of Insurance
This breaks down people who HAVE insurance by the type that they have.
Table 3. Number of Uninsured by Age
This provides uninsured by age group. The 18-44 age group is the largest component. NHIS does not break this out further which would be useful. However, we think it is reasonable to assume the same number of people within each 1 year range, giving 13/27 * 26,662,000 = 12,837,000 for the 18-30 young adult category. This means that young adults represent 31% of the total uninsured.
Table 4. Number of Uninsured by Income
This table attempts to show the income distribution of the uninsured. However, since almost 25% of the total are unaccounted for, we are concerned about using these numbers. We have no idea if these 25% are rich or poor. There are attempts to estimate this that we have not reported.
Table 5. Reason for No Health Insurance
This table attempts to show the reason a person is not insured. However, the survey permitted a participant to give more than one answer and thus these are not exclusive categories. In other words, somebody may have reported that their employer did not offer insurance AND that it costs too much.
Additionally, these reasons are not clear. "Costs too much" means something different to a young adult willing to risk no insurance because of good health and an older low income person who is having trouble with fundamental costs.
We urge EXTREME CAUTION IN USING NUMBERS FROM THIS TABLE.
Table 6. Length of Time without Health Insurance
This table indicates the amount of time that a person without insurance has been uninsured. It does not show how long they are likely to be uninsured. It is consistent with an explanation that an important component of the uninsured is due to job turnover (unemployment plus change of job by choice). Many people, particularly young ones, may choose to go without insurance in between jobs.
Table 7. Health Status of the Uninsured
This table shows how survey repondents report the state of their health. Since over 90% report good-excellent health, it is not possible to conclude that people are unable to get insurance because insurers will no carrier them due to poor health.
