I received this letter (see below) from a constituent. I thought the letter raised some good questions concerning the number of truly uninsured people in our country.
The Health Care issue is important to me. I have introduced my own version of Redesigning Minnesota’s health care system, and presented this proposal to the Health Care Task Force this summer. Linked Here. The Wall Street Journal recently wrote about the inequities in the health care delivery system. This article supports the rational behind my bill.
Even people who have health insurance today are concerned about skyrocketing costs of maintaining their coverage. As “baby-boomers” approach the age to qualify for Medicare, there is a sense of insecurity as to whether the health care delivery system in our country can be sustained.
Legislators and others will be reshaping our health care system in the next few years. Minnesota will be considering a Constitutional Amendment next year which would create a Right to health care. However, it’s important that we base our decisions on accurate information and data. The 2007 Census Report may not be the best data to rely upon.
Here is the letter from my constituent. I invite your comments.
A letter writer to the Star Tribune is quick to quip, the latest
government figures are out: 47 million Americans without health
insurance, nearly one-sixth of the country.
The writer was referring to the August 28, 2007 Census Report which
reported 47.0 million were uninsured in America.
Ever since the U.S. Census Bureau released its August 26, 2004 report on
the nation’s uninsured population, politicians have used the data to make
health insurance policy decisions, and single-payer activists have used
the data to lobby for government-mandated or administered national health insurance.
By the Bureau’s own admission, however, the data they reported
was incorrect: The number of uninsured was greatly overstated.
So while, Census Bureau officials have acknowledged the uninsured number
is inflated because the Bureau reports as “uninsured” those adults and
children who are eligible for Medicaid and the State Children’s Health
Insurance Program (SCHIP) but are not enrolled. Individuals such as the
letter writer use this once again inaccurate data to get a gut reaction.
A lot of times, being uninsured in Minnesota or America is often a
matter of choice. Most uninsured people either can afford health insurance or
qualify for government-sponsored health care programs; they just choose
not to enroll.
According to the 2006 Census report there are 8.5 million uninsured
people who make between $50,000 and $74,999 per year and 9.3 million who make
more than $75,000 a year. That’s roughly 17.8 million people who ought
to be able to afford health insurance because they make substantially
more than the median household income of $46,326. Another 10 million people
were reported who did not work at all.
A closer look reveals the Census data included more than 10.231 million
people who are not citizens.
Thus when you subtract non-citizens and those who can afford their own
insurance (28 million) but choose not to purchase it, about 19 million
people are left less than 7 percent of the population. But there are
reasons to believe that number is incorrect as well.
While the Centers for Medicare and Medicaid Services (CMS) reported
Medicaid enrollment at 51 million in 2002, the Census tabulated only 33
million, a difference of 18 million people. This same kind of undercount
happened again in 2003: The CMS reported 2 million people became
eligible for Medicaid, but the Census Bureau recorded only a 350,000 increase in
Medicaid enrollment.
This is no minor statistical snag, as the Census Bureau reports there
are more than 15 million “uninsured” individuals in households with less
than $25,000 of income. Many of these individuals meet the income test for
Medicaid or SCHIP eligibility, but they are not technically enrolled. However, as soon
as a person, who is eligible for Medicaid, but not enrolled, enters the health care system through a hospital or clinic, he or she is automatically enrolled into the Medicaid plan.
Therefore, counting this population as “uninsured” distorts the data significantly,
since these individuals can enroll at any time and have their medical expenses paid whenever they require health care.
The social policy implications of this over count are important because
the inflated numbers send the wrong message to politicians. Given that
no one who is eligible for Medicaid can be correctly described as
uninsured, spending millions of dollars to enroll these people would do no one any
good at all. These folks are not uninsured.
Data from three federally sponsored national surveys–the Survey of
Income and Program Participation (SIPP), the Medical Expenditure Panel Survey
(MEPS), and the National Health Interview Survey (NHIS)–also seek to
make an accurate count of the nation’s uninsured population.
All three surveys conclude that at any given time during a year, being
uninsured is a much smaller problem than we are led to believe by the
Census data alone. For example, only about 30 percent of the non-elderly
population who become uninsured in a given year remain uninsured for
more than 12 months. Nearly 50 percent regain health insurance within four
months.
Writing in response to the 2004 Census data report, Dr. Kirk A. Johnson,
senior policy analyst for the Center for Data Analysis at The Heritage
Foundation, highlighted the problem of taking the statistics at face
value. The Bureau’s numbers may make for eye-popping headlines, he
noted, but, “When it comes to health insurance, the Census Bureau’s own
statisticians argue that SIPP [Survey of Income and Program
Participation] provides a better measure of health insurance coverage than CPS
[CurrentPopulation Survey]. In a recent research report on the differences
between CPS and SIPP in this regard, Census Bureau statistician Shailesh
Bhandari changes from month to month, SIPP may be closer to the truth.
“In short,” wrote Johnson, “the CPS data provide an incomplete picture
on poverty and health insurance in America. Policymakers would be well
advised to look to other data, such as SIPP, to gauge what actually
happens to people who fall into poverty or lose their health insurance.
Only then will public policy be fully informed, and America can truly
have an intelligent debate on how to better address these problems.”
The fact is that the Census has repeatedly over the years underreported the number of people covered by health insurance meaning that more people have insurance than the report suggests. The Census also underreported the number of people covered by Medicare and Medicaid.
The Census Bureau’s own admission that the CPS “is not designed
primarily to collect health insurance data” speaks directly to the issue that the
methodology used to collect this important information is not up to the
task.
Moore, Clinton and Obama have used the lie about 40-some million
uninsured Americans to promote universal health insurance plans. Moore asserted in
his film that providing health insurance to everyone is a moral and even
religious obligation.
The issue of uninsured American is simply too important for its public
face to come from an indifferent and inaccurate survey and be swallowed
whole by politicians who don’t take the time to stop and evaluate
implications of their policy decisions that are driven by rhetoric and
incomplete facts and not by sound policy based on a factual review and
analysis.