Uninsured a problem hard to grasp, solve

Washington -- Experts agree that the number of Americans without health insurance is a problem. They just can't agree on how big a problem.

Next month, a national coalition of health advocacy groups, including the Robert Wood Johnson Foundation and the American Medical Association, will launch the third annual Cover the Uninsured Week. Events across the country are meant to draw attention to the plight of Americans who lack health insurance.

"Individuals and families without coverage face the challenge of finding reliable, affordable, quality health care. Many go without annual check-ups, recommended health screenings, filling needed prescriptions and seeing specialists," said Risa Lavizzo-Mourey, MD, president of RWJ. "This is simply unacceptable, and we must keep up the pressure until the problem is solved."

But disagreement over exactly how many uninsured Americans there are continues to muddy the national debate about how to fix the problem, experts said.

The Census Bureau's Current Population Survey offers the most-often-cited number of 45 million Americans without health insurance for all of 2003. But a survey by the Dept. of Health and Human Services found that only 28.8 million lacked health insurance that year. The surveys differ in size and methods.

In a separate analysis of the Census Bureau data, HHS suggested there may be as few as 9 million uninsured Americans.

Researchers arrived at that number after deducting individuals who should be in Medicaid, illegal immigrants, young adults with little or no health care costs, and people who could afford health insurance but chose not to buy it.

The variation in the basic data is larger than the impact expected from many of the policies that have been proposed by lawmakers, said Joseph Antos, a health care scholar at the American Enterprise Institute, a think tank in Washington, D.C. Incremental approaches, such as health insurance tax credits and expanding access to community health centers, would reduce the uninsured by millions, rather than tens of millions, experts said.

While the difference in estimates of the uninsured is an obstacle, it does not diminish the need for action, said Michael O'Grady, HHS assistant secretary for planning and evaluation.

"It is certainly true that we're trying to drill down, trying to have the most accurate data, but none of this should be considered in any way to suggest that this is not still an extremely significant and severe problem," he said.

The problem could become even more severe, a new study by researchers at the University of California, San Diego, shows. Their article, published on Health Affairs' Web site, suggests that the number of uninsured Americans can be expected to grow from 45 million, or 15.6% of the population, in 2003 to 56 million, or 27.8% of the population, in 2013.

"If the question is: 'Are things getting better or worse,' maybe surveys are more consistent in that way," said Leighton Ku, a fellow at the Center on Budget and Policy Priorities, an organization that conducts research on fiscal policies that affect low- and moderate-income Americans.

The projected increase in the number of uninsured would be driven largely by rising health care premiums, the article's authors said. Low- and moderate-income workers in particular would find it increasingly difficult to afford health coverage.

The authors calculate that the projected rise in the uninsured will lead to an additional 4,500 deaths annually. They based this finding on Institute of Medicine estimates of the impact of the lack of health coverage.