A Preview of Tomorrow’s Census Report on the Uninsured
Tomorrow at 10 AM, the Census Bureau will be releasing its annual update on income, poverty, and health insurance coverage for 2010. Several things to keep in mind ahead of the report’s release:
New Methodology: Tomorrow’s Census figures on the uninsured will be released using a new method for imputing health coverage to individuals that do not respond to the health insurance survey question. Liberal groups are claiming this revision will somewhat increase the number of Americans with health insurance, which would tend to reduce the number of reported uninsured. Past year’s uninsured data will be revised in tomorrow’s report to reflect the new methodological format. This is not the first time the Census methodology has been revised; many economists and statistical experts have questioned its accuracy of its uninsured estimates. (See more at the bottom of this e-mail.)
Failed “Stimulus” Means Millions More Uninsured: One of the prime reasons the number of uninsured is expected to increase again this year (methodological changes notwithstanding) is that the Obama Administration’s “stimulus” failed to bring down unemployment to promised levels. Because most Americans obtain health coverage through employment, millions more Americans would be insured if the unemployment rate were at the 6.4% level the White House promised it would be today once the “stimulus” passed, rather than the 9.1% it actually stands at.
5,110,000: Remember Democrats’ repeated claims that “every day, 14,000 Americans lose their coverage?” The number was invoked frequently during the health care debate, and President Obama even cited the statistic in his September 2009 speech to Congress. The statistic hasn’t been repeated often since the law passed, probably because its major coverage expansions don’t take effect until 2014. But if the Democrat claims were true, and 14,000 Americans lost their health insurance every day, the Census report will show the number of uninsured Americans rose by 5.1 million in 2010. However, the dubious assumptions behind the statistic make it likely that any potential increase in the number of uninsured won’t match the earlier predictions. (The short version of the story: The Center for American Progress came up with the 14,000 estimate at a time when the economy was shedding more than 500,000 jobs monthly, which is not the case now.)
Uninsured Number vs. Rate: While press accounts of the Census report tend to focus on the number of uninsured Americans, the uninsured rate has remained relatively constant for most of the past two decades (last year being an exception). Economists tend to emphasize the unemployment rate – and not the total number of unemployed workers – as the most accurate picture of economic health, as the former reduces the impact of population growth. For instance, while there are currently over 2 million more workers unemployed than there were during the 1982-83 recession, the unemployment rate is (slightly) below levels reached during that downturn, because the American workforce has grown by more than 40 million workers over the past three decades. Some may therefore argue that the uninsured rate, as opposed to the number of uninsured overall, may present a more accurate picture of the health insurance system.
Uninsured Rate vs. Unemployment Rate: The Bureau of Labor Statistics’ August employment report found a total unemployment rate – including discouraged workers who have left the workforce and part-time workers who cannot find full-time employment – of 16.2 percent. It is likely that, for the third straight year, the percentage of individuals seeking full-time work who cannot find it will approach or exceed the percentage of individuals without health coverage – a pattern not previously seen for at least two decades. This dynamic may cause many to question the logic of Obamacare’s more than $800 billion in tax increases at a time of record unemployment.
Cohorts of the Uninsured: Former National Economic Council Director Keith Hennessey has analyzed the various groups within the uninsured population to ascertain who might need assistance to purchase health coverage. The numbers are now dated (based on 2007 Census data), but it’s the best explanation out there of groups of the uninsured – those who are enrolled in Medicaid and/or SCHIP but aren’t reported on the Census survey as such, those who are eligible for Medicaid but haven’t enrolled, non-citizens, individuals who could likely afford to buy some form of health insurance, and the “young invincibles.”
More on Survey Methodology: While the Census Bureau figure of uninsured Americans is among the most widely reported, it is far from the only measure used – or the most accurate. Many indicators confirm that the Census survey represents a “point-in-time” snapshot of the uninsured population at any given moment, and does not reflect the number of individuals without insurance for long periods of time – those in most need of assistance. For instance, while last year’s Census report found 50.7 million uninsured in 2009, a separate study by the Centers for Disease Control found that 32.8 million Americans were uninsured for one year or longer in 2009, and a survey of health spending conducted by the Department of Health and Human Services found 41.3 million non-elderly Americans lacked coverage for all of 2009. In 2009, the Census survey saw a larger jump in the number of uninsured than the other two reports, which could be a result of methodological flaws, and/or the fact that many of the uninsured lacked health coverage for periods of less than a year. (For a further discussion of these issues, see also a 2006 Kaiser Family Foundation brief comparing the uninsured surveys, as well as a 2003 CBO analysis of the long-term uninsured.)
It is also worth noting that the Census survey relies on individuals to self-report their insurance status, and some individuals may not remember periods of health insurance coverage. Adding a “residual” question to the Census survey in 2000 – to confirm that those without employer, individual, or government coverage were in fact uninsured – reduced the number of uninsured Americans by 8 percent. One survey conducted for the Department of Health and Human Services in 2005 adjusted for the number of individuals which the Centers for Medicare and Medicaid Services (CMS) reported were enrolled in Medicaid, but who did not report insurance coverage for the Census survey. Such adjustments for the Medicaid undercount reduced the number of uninsured by about 9 million – or one-fifth of the total uninsured – and the number of uninsured children by half. For these reasons, the Census Bureau report itself admits that “health insurance coverage is underreported [in the Census data] for a variety of reasons,” meaning that by Census’ own admission, the number of uninsured is lower than its report indicates.