Short Takes On News & Events

Who Are The Uninsured? The Feds Parse The Numbers

By Jenny Gold

March 22nd, 2013, 6:19 AM

There are 48.4 million uninsured Americans — about 18 percent of the population — according to the last Census. But who are they? And what is the best way to get them signed up for new health insurance coverage options that roll out this fall?

The U.S. Centers for Medicare and Medicaid Services has just released a brief for those with a stake in getting people signed up, including insurers, consumer advocates and state officials. The analysis breaks the uninsured down by age, race, geography and “lifestyle and psychographic segments” (that’s marketing-speak for people who share some of the same demographic profile).

Here’s the gist:

Nearly half of the uninsured are young and healthy—that includes the so-called young invincibles, as well as older people who also “take health for granted.” They aren’t terribly motivated to enroll in coverage offered in the new online insurance marketplaces opening in October, but they’re exactly the sort of people the government needs to enter the risk pools if premiums are to be kept low. A little over half say that cost is the main reason they are uninsured.

Then there are the nearly one-third of uninsured Americans who are in poor health, and concerned about not having coverage.  These are the folks who likely need health insurance most, and are likely to sign up for it. In the current individual marketplace, they’re likely to face high insurance costs because of pre-existing conditions. Nearly 80 percent cite cost as the main reason they are uninsured.

Lastly, there are the 15 percent of the uninsured who are a bit older and in generally good health, but who don’t know a  lot about insurance. Most say they are uninsured because coverage is too expensive. Like the “young and healthy,” only about half of them say they would be interested in shopping for insurance on the exchanges.  Almost three quarters cite cost as a problem.

Other interesting facts from the report:

  • 55 percent of the uninsured are male;
  • 54.5 percent of the uninsured earn less than 138 percent of the federal poverty level, or $32,499 for a family of four, and will likely qualify for Medicaid next year in the states that expand the program;
  • 38.2 percent of the uninsured earn less than 400 percent of the federal poverty level, or $94,200 for a family of four, and will likely qualify for subsidies to purchase health insurance on the exchanges in 2014.
  • 7.3 percent of the uninsured earn too much to qualify for subsidies and may be on their own to purchase coverage;
  •  44.8 percent of the uninsured are white, 32.4 percent are Latino and 14.9 percent are black;
  • 15.7 percent of the uninsured have no English-speaking adult in their household.

13 Responses to “Who Are The Uninsured? The Feds Parse The Numbers”

  1. Jenny
    Where do undocumented folks sit?

    Both above and survey dont reference by name, and I assume the 48M includes?

    Makes interpretation of percentages difficult.


  2. Bonnie Langer says:

    Reading the entire .pdf CMS document reveled this caveat:
    “These data reflect means obtained in two independent surveys that identified the uninsured audiences in these segments, and the percentages shown are generally consistent with the overall profiles for those segments in the general audience 18 – 64 years of age. Nevertheless, the sample sizes on which these percentages are based are small, so these estimates should not be considered exact.”

    Total number surveyed: 1,600 people – out of 43 million! What a crock!

  3. Mark says:

    I’m confused. How can 54.5% earn less than 138% of the federal poverty level, but only 38.2% earn less than 400% of the federal poverty level. Shouldn’t the second group include the first group?

  4. Mike bertaut says:

    Tracking the uninsured has always been problematic. Census’ own data indicates in appendix C that the numbers are overstated by between 17 and 22% because of an error bias in the survey. Apparently that many folks who are on Medicaid don’t think of it as insurance and routinely report themselves “uninsured”

    The rubber will hit the road on 10/1 when exchanges open. If cost and health status are removed as barriers then we should see these numbers go down a lot..


  5. Ray says:

    Bonnie, 1,600 people is a valid sample, not a crock. Additionally, most of the error (as pointed out by Mike) is due to people answering incorrectly. So long as this survey was carried out correctly, there is no reason to assume that you would not receive the same or similar answers if you were to survey all 43 million. That’s some Stats 101 stuff.

    Mark, look at page 4 of the original report, the 38.2% represents people between 138% and 400% fpl (with only 7.3% of uninsured making +400%FPL).

    P.S. cost was NOT removed. Person per person, we’re paying more. It’s just being hidden behind taxes, fines, and penalties. The line-item of your premium MAY be decreased FOR THOSE ELIGIBLE, but the total cost is higher than ever, and will continue to climb.

    In states where health status has already been removed, the difference has been small.

  6. Bobsmith says:

    Bonnie, please take a basic statistics course and learn about sampling. It is valid.

  7. Killroy71 says:

    Bradley, it doesn’t make any difference where the undocumented folks sit – if they can’t prove citizenship, they can’t buy subsidized insurance through the exchanges. That’s in the law. Though they remain free to purchase it in the private market.

  8. Jill Galloway says:

    “38.2 percent of the uninsured earn less than 400 percent of the federal poverty level, or $94,200 for a family of four, and will likely qualify for subsidies to purchase health insurance on the exchanges in 2014.”

    That is 18 million people who are about to discover that their monthly premium due after subsidies will still be over $728.00 per month. Won’t that big a big surprise?

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  11. walter says:

    This article clearly shows the status quo. For Republicans, it’s health care nirvana. It’s the ideal world that Republicans describe in their most recent budget. The “final solution” that Republicans propose for Medicare in their last two failed budget proposals, allow the level of uninsured to grow by massive numbers when Republicans throw seniors into a Medicare voucher program. The Medicare voucher program that Republicans propose will force seniors to accept a capped voucher and let them fend for themselves in the cut-throat private insurance market where only the strong survive. If you are wealthy and healthy, you’ll probably survive. Poor and sick seniors will not find insurance, even with a voucher. The key to the GOP voucher plan is to never get old, never get sick and never get injured. If you think the current uninsured rate of 18 percent is high, just wait until the House GOP Budget gets enacted. We could easily see uninsured rates rise to 22 percent of the population. Under the GOP plan to repeal Obamacare, insurance companies will be free to return to their old corrupt ways of cherry-picking healthy subscribers while refusing to insure sick people. Under their old corrupt ways, private insurers could return to the common practice of tossing you off your policy if you got sick. In a Republican health care world, poor and sick seniors would be doomed!

  12. kristin Morin says:

    I agree here with Walter. One step further. Is insurance covering our needs? I have been hearing so many stories lately of how seniors have insurance, but still can’t afford co-pays, and co-insurances and are opting to not recieve care. That’s one way of keeping costs down by making the care so unaffordable, people are chosing not to accept care. I think this report is showing that we are hopeful that the insurance pools will offer something better than what we have now and that high costs are keeping people from buying in which supports other studies on this issue.

  13. Mike says:

    Insurance is not supposed to be designed as a club membership or discount card. It unfortunately has become that way over time. Too many people think they should pay some monthly premium and then everything should be free after that. That just encourages overutilization.

    The mandated benefits under the Affordable Care Act are too rich and will make policies way too costly. If you are in over 40, you probably are not too interested in maternity and newborn coverage – yet you have to pay for it. Same with mental health coverage and substance abuse disorder services. These are expensive services that you have no choice in paying for.

    If auto or home owners insurance were designed and used like medical insurance, those rates would be soon unaffordable as well. Filing claims for oil changes, wiper blades, tires or for carpeting, windows etc would cause costs to explode.

    Medical costs are too high, but if the insurance industry was changed with Health Savings Accounts and saving, prices would come down for common services like office visits, lab tests and radiology tests. The prescription drug market is screwed up since the US subsidizes all the other countries – that would be a good reform to pursue.

    This “free” Medicaid doesn’t cover the costs of additional staff to handled the case loads at individual counties or health plans.

    This will not turn out as well as people think.