Makeup of uninsured population unclear

Without an accurate picture of the uninsured, policy designed to expand coverage could go awry.

By Joel B. Finkelstein, AMNews staff. April 14, 2003.

Washington -- The problem of the uninsured has been met with many proposals, but few account for the dynamics of the uninsured, according to several health experts.

They worry that these approaches will give with one hand while taking away with the other.

"There's just a lot of moving in and out of this group of people that we call uninsured," said Pamela Short, PhD, professor of health policy and administration at Penn State University. "We need to think of the uninsured as a moving target."

According to Census Bureau data, the ranks of the uninsured have grown to more than 41 million Americans, but that number does not tell everything.

That's because the number of people who are uninsured during any point in a year remains relatively constant from one year to the next, albeit rising over time. That number looks very different, however, when broken down into groups by how long people are uninsured.

For example, an estimated 80 million people went without insurance for some period in the past two years. But 24 million Americans went without insurance for the entire past two years, while a monthly average revealed 45 million without insurance.

A cross-sectional survey, such as the U.S. Census, "gives you a picture of the uninsured that's skewed toward people who are uninsured for longer periods of time," Dr. Short said.

The risk is that policies designed to help the population of people without insurance for long periods of time can have unintended effects on other populations, said John L. Czajka, PhD, a senior researcher at Mathematica Policy Research Inc., based in Washington, D.C.