Uninsured Individuals

The number of people who do not have any type of health insurance—that is, they are not covered by private policies or public programs such as Medicare and Medicaid—has been steadily increasing since the late 1970s, when the first federal surveys began asking about the coverage of individuals rather than just the head of a household. The uninsured as a percentage of the population has also been increasing. In 2006, the most recent year for which data are available, 47 million Americans did not have any type of health insurance. This was 2.2 million more people than in 2005, and it was the largest 1-year increase in the number of uninsured since the U.S. Census Bureau started collecting insurance status data in 1979. The fraction of the nation's population who were uninsured in 2006 stood at 15.8%, and among the population under age 65, 17.8%—one in six people—are uninsured.

Being without health insurance places a person at risk for potentially catastrophic expenses if he or she develops a disease, such as cancer, or a chronic medical condition, such as multiple sclerosis, or survives a major car accident or stroke. Such expenses can cause families to declare bankruptcy. Equally concerning is that the lack of health insurance can limit a person's access to healthcare. Many physicians and hospitals will not provide nonemergency services to people who are uninsured. Furthermore, people without health insurance who are treated often are not given the newer, most effective treatments, including newer pharmaceuticals, because they cost more. Thus, being uninsured involves serious risks.

Because private health insurance coverage is strongly tied to having an employer that sponsors group coverage and Medicaid coverage is tied to meeting eligibility criteria that include a low income, there are dynamic aspects to being uninsured. Losing a job is often a trigger for losing health insurance, and likewise, changing jobs to one with a company that offers insurance can enable a person to gain coverage. Similarly, individuals can work in low-wage jobs and qualify for Medicaid, but if their employer asks them to work overtime, they can earn too much to still be eligible for Medicaid. These scenarios play out every day—people lose and gain jobs, and some lose or gain health insurance coverage, and some people lose eligibility for Medicaid, while others become eligible because of some misfortune.

These dynamics mean that over a period of time—say a year—there are people who are uninsured for part of the year while others are uninsured the entire year. Research on the dynamic aspects of health insurance coverage shows that although the median length of time that people are uninsured is about 6 months, a significant fraction (between 25% and 30%) of uninsured spells last more than a year. The implication of these studies is that surveys that ask about people's insurance situation at a point in time are not capturing the full extent to which being uninsured is a problem for people over a year or several years' time. Over the course of 2 years, the number of people who have at least 1 month without health insurance is perhaps one and a half times the number of people who are uninsured in any given week during the year when a survey may occur. Thus, the estimate of 47 million people without health insurance in any given week in 2006 could indicate that between 2005 and 2006, closer to 70 million people spent at least a month without health insurance coverage.

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