Fewer Americans uninsured all year, new report finds

But the number of people who lack insurance for part of the year is higher than previously estimated.

By Joel B. Finkelstein, amednews staff. June 2/9, 2003.

Washington -- When it comes to the debate about how to help more Americans get health insurance, numbers matter. A new report questions the most fundamental statistics in that debate: How many people lack coverage and for how long.

The figure repeated most often -- 40 million uninsured -- is based on the U.S. Census Bureau's Current Population Survey. Questions on that survey essentially ask respondents about what form of insurance they had the previous year and are meant to yield the number of Americans without insurance for an entire year.

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But the new report from the Congressional Budget Office sheds doubt on that statistic by demonstrating that many of those people will be insured again within months.

The CBO concludes that the bureau's figure more accurately reflects a point-in-time estimate of the number of people without insurance.

On closer look, the population survey statistic is made up of two groups -- 21 million to 31 million "chronically uninsured" Americans and another 10 million to 20 million people who did not have insurance during part of the year, the report notes.

But the 40 million number undercounts the latter group, experts said. Data from other surveys analyzed for the report put the combined number of long-term and short-term uninsured people at between 57 million and 59 million during a year.

To make matters more confusing, a Families USA/Lewin report released earlier this year found that nearly 75 million Americans went without health insurance for some period during the past two years.

Interpreting the numbers

According to Rep. Bill Thomas (R, Calif.), who requested the CBO report in his role as chair of the House Ways and Means Committee, the revised estimate is good news.

"Fewer individuals are long-term uninsured than previously thought," he said. "The characteristics of the uninsured have received little attention to date, so this analysis is helpful in considering solutions to providing health care to these individuals."

The change has budget consequences. "The pot of money [set aside for the uninsured] can go even further," said Ways and Means staffer Joel White.

But for those who follow the numbers, the report didn't bring much new information to the table.

"Most people in the field already knew this," said John Holahan, PhD, director of the Health Policy Research Center at the Urban Institute in Washington, D.C.

The CBO did not collect new data for the report. Instead, the authors conducted an analysis of data compiled by several large national government surveys.

Each of these surveys has its own strengths, Dr. Holahan said, but none of them presents the whole picture. However, no one should interpret the CBO report as showing that 40 million uninsured Americans is an overestimate, he warned.