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The Real Number of Uninsured Americans

It's nowhere near 50 million Americans

10:45 AM, Dec 29, 2010 • By JEFFREY H. ANDERSON
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Across the health care debate, supporters of Obamacare have tried to inflate the number of uninsured, and too often they have gotten away with it. Yesterday, for instance, a Huffington Post banner headline read, “Number of Uninsured Americans Soars to Over 50 Million.” But this claim cannot withstand examination. 

The Real Number of Uninsured Americans

The Huffington Post story relies on a “sobering new report” from the decidedly pro-Obamacare Kaiser Foundation. The Kaiser Foundation report, in turn, bases its findings of 50 million uninsured Americans (under the age of 65) on the Current Population Survey’s Annual Social and Economic Supplement (CPS ASEC), published by the Census Bureau. Kaiser describes the CPS ASEC as “the primary source of annual health insurance coverage information in the United States” and as “the most frequently cited national survey on health insurance coverage.” 

The problem is that, as the Census admits within the pages of the CPS ASEC (on page 22), “Research shows health insurance coverage is underreported in the CPS ASEC for a variety of reasons.” This concern is serious enough that the report notes, “There are several ongoing projects aimed at improving the quality of health coverage data from the CPS ASEC.” On page 69, the Census elaborates on this over-counting of the number of uninsured, admitting that while almost all surveys” inflate the number of uninsured, its CPS ASEC report inflates that number by even more than most: 

Health insurance coverage is likely to be underreported on the Current Population Survey (CPS).  While underreporting affects most, if not all, surveys, underreporting of health insurance coverage appears to be a larger problem in the Annual Social and Economic Supplement (ASEC) than in other national surveys that ask about insurance.

The Census report also admits within its own pages that recognition of its inaccuracy led to “a research project to evaluate why CPS ASEC estimates of the number of people with Medicaid are lower than counts of the number of people enrolled in the program from CMS” — in other words, to evaluate why the CPS ASEC lists millions of Americans as being uninsured while the Centers for Medicare and Medicaid Services (CMS), which runs Medicaid and keeps the official tally of enrollees, says that these people are on Medicaid. During this project, “files from the Medicaid Statistical Information System (MSIS) were linked with the CPS ASEC files and the individual records were compared.”  The conclusion?  “A key finding indicating survey response error in the CPS ASEC was that 16.9 percent of people with an MSIS record indicating Medicaid coverage reported in the CPS ASEC that they were uninsured.” 

Any private citizen can do the math from there, which the Census has done as well: 16.9 percent of the 47.8 million people on Medicaid is 8.1 million. So more than 8 million of the 50 million “uninsured” are people who aren’t actually uninsured at all, but instead are on Medicaid.

That leaves us with approximately 42 million uninsured, according to the Census’s correction of its own survey figures (a correction that Kaiser doesn’t make). Of these, according to the same report, 10 million aren’t citizens. That leaves us with 32 million uninsured Americans — a far cry from 50 million, but apparently close enough for government (or Kaiser) work. 

Are these 32 million uninsured Americans languishing in Dickensian squalor, as the advocates of Obamacare would lead us to believe?  Far from it. The Census states (in Table 9 of the CPS ASEC report) that approximately 11 million of those who are uninsured live in households that make over $75,000, while another 9 million (giving us 20 million total) live in households that make more than what the same report shows (in Figure 1, on p. 6) to be the median American household income of $49,777 annually. 

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