Progressives like Sen. Bernie Sanders, I-Vt., routinely claim that the United States is in the midst of an uninsured crisis. Just last month, the Vermont socialist lamented, "We have 85 million Americans who are uninsured or under-insured."
But as a recent report from the Congressional Budget Office shows, this national emergency exists mostly in Sanders's imagination.
The report estimates that 24.3 million Americans lack health insurance in 2023, which amounts to just over 7% of the country.
That might seem like an uncomfortably large figure. But consider another crucial fact. The overwhelming majority of uninsured residents — over 20 million — either have access to some form of subsidized health coverage or are in the country illegally.
Add it all up, and uninsured legal American residents who lack access to subsidized coverage account for just over 1% of the population.
The real problem with American health care isn't that too many people can't secure insurance. It's that Democrats have made insurance so unattractive that huge segments of the country would rather go uninsured than avail themselves of even heavily subsidized coverage.
The current uninsured population breaks down into several distinct groups.
First, consider the 10.8 million Americans who are eligible for some form of subsidized health insurance but have failed to sign up for a plan. Of these, 5.3 million have access to subsidized employee-sponsored coverage, 4.4 million qualify for subsidies through the Obamacare exchanges, while 1.1 million are eligible for Medicare Part B.
Why would someone willfully forgo such coverage options? The most obvious answer is that they don't think it's worth the cost.
In the case of employer-sponsored coverage, the average employee contribution to a family plan in 2023 was $6,575 over the course of the year. For those who don't expect their annual health costs to exceed that figure — particularly younger, healthier patients — spending that much on premiums could seem excessive.
It's also striking that millions of uninsured Americans are eligible for subsidized coverage on the Obamacare exchanges.
The 2010 health law sent the price of individual coverage soaring, largely due to its distortionary insurance market regulations, which took effect in the 2014 plan year and effectively outlawed bare-bones, low-cost insurance. But increasingly generous federal subsidies have insulated most patients from the true cost of these plans.
Most recently, the August 2022 Inflation Reduction Act ensured that no individual — not even the very wealthy — would have to pay more than 8.5% of his or her income for exchange coverage through 2025.
Even with such generous government assistance, 4.4 million people would rather go uninsured than settle for what's sold on the Obamacare marketplaces.
The lesson to draw from these findings is clear. What Americans want and need isn't gold-plated health coverage that's subsidized by the government. It's genuinely affordable insurance that's tailored to their unique healthcare requirements — the very sort of product that Obamacare deliberately removed from the market.
The 4.3 million uninsured Americans who are eligible for Medicaid tell a different story altogether. They have access to coverage at essentially no personal cost.
It's true that some of them might not know they're eligible. But many others simply haven't bothered to sign up. And given how subpar the care is, combined with the difficulty in finding a doctor who will take Medicaid, that might be a rational decision.
The most rigorous analysis of Medicaid's health effects ever conducted shows why. The study compared patients randomly selected for an expansion of Medicaid in Oregon against a similar group of uninsured patients.
The researchers found that, when measured against the uninsured control group, "Medicaid coverage generated no significant improvements in measured physical health outcomes" for enrolled patients after two years.
In other words, the evidence suggests that enrolling in Medicaid is no better than remaining uninsured. And patients can always get treatment, even routine care, in an emergency room if necessary. That's one of the reasons why the cost of uncompensated care at hospitals is so high.
America doesn't suffer from an uninsured crisis. It suffers from a lack of coverage patients want, need and are able to afford. And that very real crisis has been made far worse by years of costly, ineffective Democratic reforms. Rather than obsessing about an imaginary problem, policymakers should get to work solving the one we actually have.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.
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