What it Means to Be 'Uninsured'

Is the so-called "individual mandate" a necessary and valuable component of sweeping health-care legislation? Should every individual be legally required/mandated to carry some type of health insurance that would also cover all pre-existing conditions? This issue is generating much bipartisan interest. If insurance is not obtained through one's employer or some other group, laws would mandate that an individual purchase his or her own insurance. Those who could not afford it would receive help by way of an advance, refundable tax credit or sliding-scale premium subsidies provided by the government to either the individual or to the employer. Those who do not comply would pay substantial fines or penalties.

If properly constructed, this would rule out the need for a separate, competing government plan and avoid the likely scenario of people leaving private insurance and moving to a government plan, which would require a significant and costly bureaucracy to administer.

Before we put into place such major changes as an individual mandate or a government plan, it would be helpful to carefully examine the demographics of the 48 million "uninsured" to determine the real numbers. According to the Healthcare Leadership Council, of the 48 million "uninsured":

8.4 million are eligible for Medicaid/Children's Health Insurance Program but not enrolled
10.2 million are not U.S. citizen
4.7 million are college students
9.2 million have annual incomes greater than $75,000

So the remaining uninsured is actually 14.5 million to 17.5 million (or 24.5 - 27.5 million if the non U.S. citizens are included - US Census, 2006). Interventions designed for each of these groups would need to be different and may not be solved by individual mandates. Of course, we must not forget that more than half of the insured population is covered by the Veteran's Administration, The Federal Employees Health Benefit Plan, the Military, Medicaid, Medicare, and the State Children's Health Insurance Program (SCHIP).

The semantics involved when people define what they mean by "individual mandate" and "personal responsibility" are confusing, at best.

Flexibility in options is the key. We can bolster the health "safety net" without adding a government-run program by doing a better job of educating the currently un-enrolled - and then subsidizing the truly uninsured.

By Colleen Conway-Welch  |  July 9, 2009; 5:01 PM ET  | Category:  Insurance
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