How What We Think We Know about the Uninsured Really Adds Up

Chair Maloney and Members of the Committee:

Thank you for inviting me to testify before you today. I am a resident fellow at the American Enterprise Institute. This testimony has been prepared and submitted in advance of today's release of the annual Consumer Population Survey (CPS) on Income, Poverty, and Insurance Coverage, as conducted by the U.S. Census Bureau. Hence, rather than try to hit an unknown and moving target in advance, I will attempt to help place within a broader context whatever those latest findings might suggest regarding the most recent level and nature of persons lacking insurance in the U.S. I primarily will be drawing upon some recent work of mine at AEI regarding what we do know more broadly about the uninsured, some of the limitations in trying to measure the scope and dimension of the problems of the uninsured, and several often-neglected considerations in assessing the broader issue of how to improve health outcomes at lower overall costs.

Pick a Different Survey and Get a Different Number of Uninsured Americans

One normally begins with trying to determine just how many Americans lack health insurance. The short answer is "too many," but the total numbers depend on whom you ask and how they measure the problem. The CPS provides the most commonly reported figure. It was about 45.7 million people for 2007, as of last year's survey released in August 2008. Although that estimate actually was lower than the 2006 figure of 47 million, we should know by the time of today's hearing how much the number of uninsured has increased since then, due in large part (if not solely) to the devastating effects of a recession that began early last year, deepened throughout 2008, and had yet to end as of the second quarter of this year.

Two other surveys by the federal government report different estimates of the uninsured, because they are handled by other federal agencies, use somewhat different ways to measure the problem, and assess it for different periods in time. The National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, reported in June that 43.8 million persons of all ages were uninsured at the time of their interview in 2008. The NHIS provides several additional measures of the uninsured beyond what is increasingly viewed as more of the single "point in time" estimate provided by the CPS. The latest NHIS report also finds that 55.9 million had been uninsured for at least part of the entire year of 2008 prior to the interview, and 31.7 million had been uninsured for more than a year at the time of the interview.

Click here to download this testimony as an Adobe Acrobat PDF.

Thomas P. Miller is a resident fellow at AEI.

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