Uninsured Idahoans

I saw a letter to the March 26, 2008 Idaho World from Walt Minnick, the Democrat intent on unseating Bill Sali, attacking Sali for his approach to solving the problem of uninsured Idahoans. In that letter, Minnick complained about "the 40% of Idahoans who don't have insurance." That sounded high, but I just assumed that Minnick is as careful as I am when making factual claims. I guess not.

Here's a website sponsored by the Robert Wood Johnson Foundation, which wants everyone covered. It claims that the 2006 Current Population Survey data indicates that 14.7% of Idahoans are uninsured. That's actually better than the national average (although not by much).

Here's a report put together by Mathematica Policy Research for the Joint Legislative Oversight Committee last year. It estimates that 16-18% of the "non-elderly population" of Idaho is uninsured as of 2005. (People over 65 are covered by Medicare; hence the discrepancy with the 14.7% figure.)

Characteristics of the uninsured are unsurprising: the 18-24 and 25-34 populations seem to be especially prone to being uninsured, while only 10% of the 0-17 population are uninsured. My guess is that this is because large numbers of Idahoans graduate either high school (and don't go on to college) or graduate college, and because they are now either not full-time students, or are too old, are therefore no longer covered by the health insurance that their parents have. Been there, done that, long, long ago.

I'm not thrilled that 10% of the 0-17 population are uninsured, but it is pretty obvious from the numbers that 90% of children are insured, either privately, or through governmental insurance programs such as Medicaid or SCHIP.

Why are there Idahoans who are uninsured? I was uninsured for a few months, back when I was 19 years old, mostly because I wasn't thinking about it. I worked for an employment agency with no benefits (but they paid me so well that I couldn't spend money as fast as I made it) and I just never thought about the need for health insurance. After a few months, I did start to think about it, and I went out and bought individual health insurance that covered just hospitalization--figuring that I would pay everything else out of pocket. It made the coverage a lot more reasonable.

I'm guessing that many of Idaho's uninsured are in that situation because of poverty. I see that 49% of the roughly 45,000 adults with incomes below $15,000 per year are uninsured--and I would expect that most of these can't afford health insurance, and are too well off to qualify for Medicaid. Ditto for the 48% of the roughly 70,000 adults with incomes in the $15,000 to $25,000 per year range. Health insurance is going to run you, even for a very basic policy, at least $300 to $400 a month.

But there are still uninsured adults making more than $50,000 a year. Not as many, or as high a percentage--but whatever is causing 4% of people in this income bracket to be uninsured, poverty isn't likely the reason. That's a net income of about $3000 per month. You can afford to buy insurance with that kind of income--and if you can't, that's a foolishness problem, not a poverty problem.

Much of the problem seems to be with unemployed people, those living in rural areas, and working for small employers. Of employers with less than 10 employees, only a bit more than 30% offer health insurance to their employees.

Part-time employees, also unsurprisingly, are uninsured. Most group health insurance plans are only available to full-time employees (either 30 or 32 hours per week, depending on the plan).

If we want a solution to the problem, the focus needs to be on:

1. Reminding those that can afford health insurance, but don't have it, that this is really, really foolish.

2. Seeing if there something that can be done to make it possible for the group health insurance to be offered on some basis other than employers. I don't know all the details of how and why group health insurance is tied to employers and labor unions, but I know that the Bush Administration repeatedly tried to get federal law changed to allow Association Health Plans to cross state boundaries, for this very reason.

3. Pretty clearly, there are a lot of young adults who are not insured, and in many cases, may not be able to afford to pay for their own insurance. I'm not thrilled at the idea of the government going into the health insurance business. On the other hand, being uninsured just results in hospitals transferring costs from uninsureds that can't, or won't pay their bills to people who have insurance. Perhaps we could persuade health insurers to market a bare bones insurance plan that at least covered hospitalization and emergency room visits to these uninsureds?

There are some people covered by health insurance that is abominably bad. The health insurance that BSU offers to its students is really health insurance for those who aren't going to need medical care. If a private employer offered a policy this absurd, the left would be screeching about capitalists engaged in fraud.