How Health Overhaul Would Affect The Uninsured

By Christopher Weaver

Published September 21, 2009 12:01 AM

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How many Americans are uninsured?

According to the Census Bureau, in 2008, more than 46 million Americans — about 15 percent of the population — did not have health insurance. Because of the recession, many experts believe the number is now larger.

Who are the uninsured?

Income is a strong factor in identifying the uninsured. About two-thirds of uninsured Americans earn less than twice the federal poverty level, which is $22,050 for a family of four. Almost 25 percent of the uninsured are poor enough to be eligible for Medicaid but are not enrolled.

Nearly 80 percent of the uninsured are U.S. citizens, and 15 percent are undocumented immigrants.

The vast majority of the uninsured — 80 percent — are in working families. And a higher percentage of minorities are uninsured than whites.

Thirty percent of people between the ages of 19 and 29 are uninsured, the highest of any age group. Although many of these young people are working, their wages are often too low for them to afford insurance.

For some, their employer doesn't offer insurance and individual coverage is too expensive. For others, pre-existing medical conditions can restrict their access to insurance. And others, believing that they are in good health and will not need it, opt not to buy insurance.

The uninsured are less healthy. While about 60 percent report they are in excellent or very good health, 10 percent say they are in poor or fair health. That's twice as many as those with coverage.

Even though Census Bureau figures indicated that more children slipped into poverty, their uninsured rate dropped from 11 percent in 2007 to 9.9 percent in 2008. The decline reflected the expansion of two government programs: the Children's Health Insurance Program and Medicaid.

Who pays the medical bills of the uninsured?

A study last year in the journal Health Affairs estimated that uninsured patients received about $86 billion in care in 2008. Of that amount, $30 billion came out of their pockets, leaving more than $56 billion in uncompensated care: $35 billion for hospitals, nearly $14 billion for community-based providers and close to $8 billion for private physicians.

Some of those uncompensated costs are recouped by hospitals and providers through government programs established to help subsidize care for the poor.

Charities also provide some support, such as funding free clinics. The remainder is shifted to insurers and their customers in the form of higher charges for health care. The Health Affairs study estimated that the amount insurers and customers paid for the uninsured was $14.1 billion, although other groups, including the liberal health advocacy group Families USA, argued that insurers and customers feel even more of the burden.

How could the current proposals affect the uninsured?

The Democratic proposals would require most people to buy coverage. The House bills and the Senate Committee on Health, Education, Labor and Pensions bill call for a requirement for most employers to provide insurance to workers (the Senate Finance Committee bill does not). All of the Democratic proposals would establish insurance "exchanges" with standardized premiums to enable individuals or businesses to compare and buy plans.

The bills would expand Medicaid coverage to include some people who don't qualify now for various reasons, including their incomes, and would provide subsidies to help low- and moderate-income people buy insurance. At least 9 percent of uninsured Americans make too much money to get subsidies, even under the most generous proposal. And some people who receive subsidies may still find that the total cost of insurance, including co-payments and deductibles, is unaffordable.

Illegal immigrants would not be able to buy insurance under any of the plans proposed.

The proposals also seek to reduce the number of uninsured by barring private insurers from rejecting applicants who have pre-existing conditions.

This story was produced through a collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

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