Uninsured by Choice

At least 44% of the uninsured are uninsured by choice, and the number could be much higher than that. An Urban Institute study found that:

  • One in every four uninsured persons is eligible for Medicaid or SChip, but has not enrolled.
  • One in five has a family income in excess of $58,000 and presumably can afford coverage.

This is a minimum estimate. Of those who earn less than $58,000, there are undoubtedly many who can afford coverage because:

  • They have access to an employer plan, (almost one in five uninsured turn down employer coverage.)
  • Even if their employer does not provide health insurance, they have opportunities to work for employers who do, but choose not to.
  • They are young and healthy or live in rural areas and face premiums much lower than the $9,961 annual premium assumed by the Urban Institute scholars.
  • They are near retirement and can draw on assets to pay premiums until they become eligible for Medicare.

If you missed this story, it is understandable. Our friends at Commonwealth and Health Affairs have it listed under "More Than Half of Uninsured Cannot Afford Coverage and Are Not Eligible for Public Programs," which makes you wonder who is writing their headlines these days. To be fair, the authors of this study are the source of misleading headlines. They started with a serious study of how many millions of the uninsured can afford coverage and turned it into unsupportable claims about who cannot afford it. Surprisingly, I do not believe the words "uninsured by choice" appear anywhere in the study itself.

Comments (10)

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  1. Rodney W. Nichols says:

    Congrats for YOUR efforts to bring clarity and integrity to the public chattering. Rodney W. Nichols Consultant on Science and Technology Policy

  2. Don McCanne says:

    Dr. Goodman, My take on this Urban Institute study was quite different, and anticipated your comments (which you have made previously): http://www.pnhp.org/news/2006/november/can_the_uninsured_af.php I've often tried to visualize any reform on which we could agree. I draw a total blank. Best regards, Don Don McCanne, M.D. Senior Health Policy Fellow Physicians for a National Health Program http://www.pnhp.org

  3. Donna B. Rovito says:

    I can see why they don't actually USE the term – "uninsured by choice" would suggest that individuals should HAVE a choice about health care, which most policy "wonks" seem to think they aren't smart enough for…. Donna B. Rovito Editor, Liability Update

  4. Matt says:

    Donna, would that be similar to how you believe juries aren’t smart enough to determine malpractice or the compensation for the harm it causes? In fact, aren’t you one of those “wonks” who expressly advocates to remove those functions from individuals?

  5. peter says:

    john goodman receiving the pioneer in health economics award from Consumers for Health Care Choices:


  6. The big deal about being uninsured is not that the insured don’t have tax deductible health insurance, but that the politicians haven’t seen fit to grant their health care costs tax deductible equity with those with insurance.

    It’s perhaps the largest form of discrimination remaining in the US laws that insurance paid for health care is totally tax deductible, while virtually ALL other forms of paying for health care remain not tax deductible. This includes people who take out loans prior to, or after receiving care. Interest as well as principle isn’t covered while the 15-20% overhead of insurance enjoys tax deductibility. Also included in tax deductibility is the copayments for care not covered by insurance (which discriminates against those with more frugal insurance plans).

    The books are heavily stacked against equality in means of health care financing…

  7. John says:

    I am an insurance broker. I’ve been a proponent for the HSA, as far back as the beginning, when they were known as the MSA. When the MSA arrived, I told people about them and some, some of the people thought it was a lie.

    Our current system has some problems of efficiencies and things like pre-existing situations. What will get me on my stump, the stump where I will cry foul is on the uninsured figures we hear from the government.

    How many times I can not count, that I’ve had small employers present the idea of health insurance to their employees and the employees decline. They decline because they are young, feeling that they don’t need it or older and not wanting to pay for it.

    Just 10 minutes ago I received an e-mail from someone that I had quoted an HSA plan. They finally responded by saying, ” i have put our names on the waiting list for Pennsylvania’s adult basic. it is the only way we can afford insurance”. Their family makes more money than my family but I somehow can pay for my own medial insurance. I don’t have that brand new car like they do and I didn’t take that trip to the Caribbean but I do pay for my own insurance. The previous scenario plays out all the time for me, a small broker. I can only imagine how many times it plays out across the landscape of the entire USA.

    So when I hear the 44 million uninsured figure I know…because I know, that many are uninsured by their own choice. I believe that the tide too strong to turn the politicians away from socialized medicine. It will be fitting that those that by choice, refused to pay for health insurance will by law, pay for it through taxes. It is kind of ironic and a fitting end to their false sense of entitlement.

  8. Physicians in Pennsylvania

    Why didn’t anyone tell me about this blog earlier? Lol. Seriously, awesome work on this post (along with your other posts…) Keep it up!

  9. andersonsmith says:

    Health care economists have lately reached a remarkable consensus regarding the best approach to solving these problems. Alternatively called consumer choice, defined contribution, and voucher system. These new approaches explicitly limit the role of purchasers in making health care decisions and put the marketplace power into the hands of consumers. ____________________________ Anderson smith Addiction Recovery Kansas

  10. Gladis says:

    At least for me my health inasnurce will cover emergencies when I’m out of the country. I’m American though, I’m not sure about for others. Not sure if you can purchase another travel inasnurce policy though.