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The Number of "Uninsured": Past and Future

For decades, there were lots of numbers being thrown around about how many "uninsured" there were, so I avoid numbers, but 45 million was about the highest.  The "inconvenient truth" of the tabulation of the "uninsured" was that by the time you sifted through the various reasons people were uninsured, about 75% were not really uninsured in the sympathetic way that the term connotes. 

>For example, a person was counted as "uninsured" if they were uninsured for even one day in the year.  So, think of the millions of people who may have been uninsured for some very short period of time changing from one job to another, or new graduates taking time off or finding a job.  So counting them was statistically misleading.

 >The second largest group were/are people who make the calculation that it is cheaper to be uninsured than to pay premiums.  Some of these are clever people who realize that if they show up at the hospital or go to a clinic for free care, there is no deductible or co-pay if they are uninsured. 

>A few million were/are young or very healthy...the so-called "invincibles"...who figure they'll never need medical care that would cost more than what they'd pay in premiums.  Interestingly, doctors & medical personnel were a significant percent of this group, because they had access to at least basic care as "professional courtesy" from fellow doctors or at the medical facility where they worked.

>>The corporate changes of the 1990's gave birth to tens of thousands of early-retiree or laid-off executives starting their own small consulting firms, often making very good money or having received a golden parachute.  This group was defined as people who made at least $75,000 a year and thus were presumed to be able to afford health insurance of some kind, but chose not to.  This group was often just coasting until Medicare eligibility, and they were the group advocating for an early-enrollment option for Medicare.

>>A few more million were eligible for existing coverage programs such as Veterans Administration, Mediciaid, Medicare or state/local programs...but they chose not to use those because they “never got around to it”, had a bad experience or didn’t trust “government”.  >>Some simply had phobias or religious issues about any kind of medical care, even from free clinics.  This group and the prior one tended to be homeless or with known or unknown mental problems.

So, by the time you subtract all of those tens of millions of people who were voluntarily uninsured, the number of people who truly had no options for health care or coverage was a small workable number who could have ben given lifetime health care or coverage for a tiny fraction of what health reform has already spent.  LOOKING AHEAD: Though the final fate and shape of PPACA is unknown, the number of Americans without insurance and a similar percentage of voluntarily uninsured will be about the same as before the law.  The adult-children-to-age-26 provision will lessen the number of uncovered students and recent graduates without insurance.  However, the guaranteed-issue requirement adds greatly to the appeal of being uninsured, because a person can literally sign up for coverage only when he is on his way for an expensive medical treatment, and stop paying for insurance when the costs stop.  There is much legal talk about the individual mandate to have coverage.  If the mandate stands, the penalties will be hard to track & enforce and less than the gains of not paying for coverage.  If the mandate is struck down, it will be a free-for-all to not be insured and get coverage only when needed.