The Uninsured And The Affordability Of Health
Examining subgroups of uninsured Americans uncovers certain
patterns of coverage gaps, but affordability remains a key concern.
by Lisa Dubay, John Holahan, and Allison Cook
The 2005 Current Population Survey (CPS) is used to estimate what share of
uninsured Americans are eligible for coverage through Medicaid or the State Children’s
Health Insurance Program (SCHIP), need financial assistance to purchase health insur-
ance, and are likely able to afford insurance. Twenty-five percent are eligible for public cov-
erage, 56 percent need assistance, and 20 percent can afford coverage. This varies across
uninsured populations: 74 percent of children are eligible for public programs, and 57 per-
cent and 69 percent of parents and childless adults, respectively, need assistance. A cen-
tral conclusion is that a large percentage of uninsured adults need help purchasing health
26, no. 1 (2007): w22–w30 (published online 30 November
uring the past five years,
number of uninsured Americans in-
creased by more than six million, ris-
ing from 39.6 million in 2000 to 46.1 million
(nonelderly) in 2005.
This is a major policy
concern for a number of reasons. To begin
with, lack of insurance coverage has adverse
effects on the uninsured themselves. Despite
being in worse health status than people with
coverage, the uninsured use fewer services
and face higher out-of-pocket spending than
their insured counterparts.
cal expenses by the uninsured have been
shown to be an important contributor to U.S.
In addition, hospitals
and other providers face increasing demands
for care by the uninsured for which there is
little or no reimbursement. This places fiscal
stress on these institutions and on the local
governments and philanthropies that sup-
The predominant vehicle for health insur-
ance coverage in the United States is employ-
ers, which cover 161 million nonelderly people.
Another large source of coverage, particularly
for low-income people, is Medicaid, which
covers children, parents, the disabled, and in
some states, other adults. Children and some
adults, mostly parents, also receive coverage
through the State Children’s Health Insurance
Program (SCHIP). Together, Medicaid and
SCHIP provide insurance to almost thirty mil-
Another fourteen million people
obtain coverage through the direct purchase
market, and others are covered through Medi-
care and military health insurance programs.
Together these various types of insurance ex-
tended coverage to 209.5 million Americans in
30 November 2006
©2006 Project HOPE–The People-to-People Health Foundation, Inc.