Advocacy Groups Inflate Number of Uninsured

Published May 1, 2003

Three of the most powerful advocacy groups in the country spearheaded an unprecedented $8 million campaign to persuade Americans to take yet another step down the road to a single-payer health care system.

The Robert Wood Johnson Foundation, Families USA, and Commonwealth Fund were the driving forces behind “Cover the Uninsured Week” (March 10-16)–an intense effort to turn Medicare into something resembling the antiquated and crumbling health care systems of Canada and England.

Fiction into Fact

The number of uninsured in America is, without doubt, a major social issue meriting our concern and policymaking efforts. But by exaggerating and misrepresenting the reasons Americans are uninsured, the Cover the Uninsured propaganda blitz seems less aimed at helping the truly needy than it is designed to advance the threadbare statist agenda of price controls, insurance mandates, and expanding Medicare.

A 53-page study by Families USA claims an eye-popping 74.7 million people under the age of 65 in the United States went uninsured “for all or part of a two-year period from 2001 to 2002.” Ron Pollack, head of Families USA, uses this figure to call for “real and meaningful action to expand health coverage.”

But Pollack’s estimate of the number of uninsured is meaningless. Anyone who was uninsured even briefly during the two-year period gets added to the “uninsured” population. It’s like calling “unemployed” anyone who took a week or month off between jobs, or tagging as “homeless” anyone who moved from one house to another. Remove from Pollack’s figure the 26.2 million Americans who were uninsured for only one to five months, and you reach a more plausible uninsured figure of 48.5 million.

The more commonly cited estimate of the number of people without insurance for some length of time in a single year is 41 million. Yet even this number is suspect, because emerging studies indicate about half those people were uninsured for a brief period of only three months or so, with the balance being chronically uninsured because of medical conditions, economic conditions, or voluntary choice. (Yes, some people, especially those who are young and healthy, make a perfectly rational decision to self-insure.) Another 9 million of the uninsured are legal and illegal immigrants.

Who Are the Uninsured?

A current report by the Blue Cross Blue Shield Association finds more than 14 million of the 41 million uninsured are eligible for Medicaid or the State Children’s Health Insurance Plan (SCHIP), but have not enrolled. More than 15 million have incomes of $50,000 or more and would purchase insurance if they thought it valuable, but they choose not to. The fastest-growing population of uninsured people earns an income of $75,000 or more.

According to the Blue Cross study, 5.7 million are short-term insured, such as recent college graduates or people between jobs. The report also indicates 5.2 million uninsured are in three states with a high number of illegal immigrants: California, Texas, and New York.

Do these numbers suggest the need for expanding government-run health care to middle-income and upper-income families, imposing new regulations on health insurers, or violating the patent protections of drug manufacturers … all reforms advocated by the groups responsible for the Cover the Uninsured campaign? I think not.

The benefit and procedural mandates they propose would waste billions of dollars solving the uninsured problem, and yet would likely miss the population needing the most help. Just as important, new mandates would further undermine a private health insurance marketplace that offers the best hope of solving the real problems afflicting the nation’s health care finance and delivery system.

Insurance and Health

In addition to using overstated statistics to advance their agenda, promoters of Cover the Uninsured Week would have us also believe not having health insurance is a cause of health problems.

While more research is needed to understand the health insurance-health quality dynamic, some studies have shown the uninsured do not suffer greater health problems than the insured.

Dave Kopel, research director at the Independence Institute, recently reported the National Bureau of Economic Research (NBER) found “the lack of health insurance among the self-employed does not affect their health. For virtually every subjective and objective measure of their health status, the self-employed and wage earners are statistically indistinguishable from each other.”

There are four viable solutions to the uninsured problem: Expanding high-risk health insurance pools for the medically uninsurable in every state; repealing insurance coverage mandates that encourage people to go without insurance until they become ill; making medical savings accounts permanent and more flexible; and passing individual and refundable tax credits for every American citizen–over and under the age of 65, currently insured, uninsured, employed, self-employed, and unemployed. Leave no one out.

The powers behind Cover the Uninsured Week oppose each of those reforms, desperately promoting their own agenda by distorting and ignoring the facts.

Conrad F. Meier is senior fellow in health policy and managing editor of Health Care News. His email address is [email protected].

For more information …

The Blue Cross Blue Shield Association fact book, The Uninsured in America, is available from the BCBS Web site at

The National Bureau of Economic Research’s September 2001 working paper, “Insurance and the Utilization of Medical Services among the Self-Employed,” is available for $5.00 from the NBER Web site at