A Preview of Tomorrow’s Census Report on the Uninsured
Tomorrow at 10 AM, the Census Bureau will be releasing its annual update on income, poverty, and health insurance coverage for 2009. Several things to keep in mind ahead of the report’s release:
5,110,000: Remember Democrats’ repeated claims that “every day, 14,000 Americans lose their coverage?” The number was invoked frequently during the health care debate last year, and President Obama even cited the statistic in his September 2009 speech to Congress. The statistic hasn’t been repeated often since the law passed, probably because its major coverage expansions don’t take effect for another three-plus years. But if the Democrat claims are true, and 14,000 Americans lost their health insurance every day, the Census report will show the number of uninsured Americans rose by 5.1 million in 2009. However, the dubious assumptions behind the statistic make it likely that any potential increase in the number of uninsured won’t match the earlier predictions. (The short version of the story: The Center for American Progress came up with the 14,000 estimate at a time when the economy was shedding more than 500,000 jobs monthly, which is not the case now—and by linking loss of health insurance to lost jobs, implicitly placed the blame for the rising number of uninsured on the Obama Administration’s failed predictions about the employment effects of their “stimulus” policies.)
Uninsured Number vs. Rate: While the number of uninsured Americans in absolute terms has risen in recent years, the rate of uninsurance has remained relatively constant within a range of 14-15 percent for at least two decades, according to the Census data. While press accounts tend to focus on the number of uninsured Americans, economists emphasize the unemployment rate—and not the total number of unemployed workers—as the most accurate picture of economic health, as the former reduces the impact of population growth. For instance, while there are currently 2.8 million more workers unemployed than there were during the 1982-83 recession, the unemployment rate is (slightly) below levels reached during that downturn, because the American workforce has grown by more than 40 million workers over the past three decades. Some may therefore argue that the uninsured rate, as opposed to the number of uninsured overall, may present a more accurate picture of the health insurance system.
Uninsured Rate vs. Unemployment Rate: The Bureau of Labor Statistics’ August employment report found a total unemployment rate—including discouraged workers who have left the workforce and part-time workers who cannot find full-time employment—of 16.7 percent. Last year’s uninsured rate of 15.4 percent marked the first year in at least two decades that the percentage of individuals seeking full-time work who cannot find it exceeded the percentage of individuals without health coverage – a phenomenon that could repeat itself this year. This dynamic may cause many to question the logic of the health care law’s more than $500 billion in tax increases at a time of record unemployment.
Cohorts of the Uninsured: Former National Economic Council Director Keith Hennessey has analyzed the various groups within the uninsured population to ascertain who might need assistance to purchase health coverage. The numbers are now slightly dated (based on 2007 Census data), but it’s the best explanation out there of groups of the uninsured—those who are enrolled in Medicaid and/or SCHIP but aren’t reported on the Census survey as such, those who are eligible for Medicaid but haven’t enrolled, non-citizens, individuals who could likely afford to buy some form of health insurance, and the “young invincibles.” His blog post is a good read in its own right, but I’ll try to pass along updated numbers when the report comes out tomorrow.
Survey Methodology: While the Census Bureau figure of uninsured Americans is among the most widely reported, it is far from the only measure used—or the most accurate. Many indicators confirm that the Census survey represents a “point-in-time” snapshot of the uninsured population at any given moment, and does not reflect the number of individuals without insurance for long periods of time—those in most need of assistance. For instance, while last year’s Census report found 46.3 million uninsured in 2008, a separate study by the Centers for Disease Control found that 31.1 million Americans were uninsured for one year or longer in 2008, and a survey of health spending conducted by the Department of Health and Human Services found 40.7 million Americans lacked coverage for all of 2008.
In addition, the Census survey relies on individuals to self-report their insurance status, and some individuals may not remember periods of health insurance coverage. Adding a “residual” question to the Census survey in 2000—to confirm that those without employer, individual, or government coverage were in fact uninsured—reduced the number of uninsured Americans by 8 percent. One survey conducted for the Department of Health and Human Services in 2005 adjusted for the number of individuals which the Centers for Medicare and Medicaid Services (CMS) reported were enrolled in Medicaid, but who did not report insurance coverage for the Census survey. As discussed above, such adjustments for the Medicaid undercount reduced the number of uninsured by about 9 million—or one-fifth of the total uninsured—and the number of uninsured children by half. For these reasons, the Census Bureau report itself admits that “health insurance coverage is underreported [in the Census data] for a variety of reasons.”