Number of US Uninsured Might Be Overstated, New Research Suggests

Main Category: Public Health
Article Date: 27 Apr 2005 - 9:00 PDT

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The number of US residents without health insurance may be overstated by as much as nine million people, according to two new analyses of census data, the... Los Angeles Times reports. The studies were commissioned by HHS Assistant Secretary for Planning and Evaluation Michael O'Grady after four government surveys found the number of uninsured in 2003 ranged from 19 million in the Survey of Income and Program Participation to 45 million in the Current Population Survey. Both surveys are conducted by the Census Bureau, but the CPS is "relied on most widely," the Times reports. One analysis by Actuarial Research Corporation estimated that nine million, or 20%, of the 45 million uninsured had health insurance coverage in 2003. The second analysis by the Urban Institute, based on data from 2001, estimates that four million of the 45 million uninsured had coverage. Both studies conclude that the CPS overestimated the number of uninsured because it undercounted the number of residents enrolled in Medicaid programs. Although it "remains unclear" why the numbers vary by so much, one hypothesis is that residents might answer "no" to health insurance questions to avoid follow-up questions on the "lengthy" survey or that residents do not want to say they receive public assistance, according to the Times. Revised estimates of the number of uninsured U.S. residents might not be available until 2006, O'Grady said. Both studies also found that the uninsured population is growing as more residents lose private coverage.

Implications
According to the Times, a reduced number of uninsured residents "could have broad consequences for the health care debate" and state SCHIP programs, which receive allocations of federal funds based on the survey data. Recalibrating the estimate of uninsured residents could reduce or increase states' shares of the $5 billion pool of federal funds used for state SCHIP programs but would not affect the overall amount of federal funding.

Reaction
Joseph Antos, a health policy analyst with the American Enterprise Institute, said that politically "there would be a lot less interest in dealing with the uninsured if it turned out there weren't so many," adding, "There would be accusations that (the administration) was rigging the numbers to make a serious problem go away." O'Grady said, "Nobody is trying to diminish this problem -- this is still a big, serious public health problem. We're trying to give policymakers the best data available so it feeds into a policy development process that reduces the number of uninsured Americans." Charles Nelson, assistant chief of the Census Bureau income division, said, "People can have their opinions about which (new estimate) is closer to the truth, but clearly this is good research. How we turn this research into recalibrating actual survey results is something we have to look at." He added that the bureau is "looking at ways of improving our estimate so people covered by Medicaid report" such data. Linda Giannarelli, senior research associate at the Urban Institute, said, "Whatever method one applies, we're still going to get rising uninsurance. This problem is not going to go away." Uwe Reinhardt, a Princeton University economist, said he agreed that the estimates of the uninsured likely were overstated, but he added, "Instead of addressing the problem, we say we must count the uninsured. It is literally, in my view, like making sure we know how many deck chairs we have on the Titanic" (Alonso-Zaldivar, Los Angeles Times, 4/26).

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