Honest Talk About California’s Uninsured
Last month, the UCLA Center for Health Policy Research released its California Health Insurance Survey, and the media promptly sounded the alarm. According to the March 16 Los Angeles Times, “nearly 1 in 4 Californians under age 65 had no health insurance last year.”
With that kind of horror story, how can 58 percent of Americans, according to an April 12 Rasmussen poll, want to repeal the new federal takeover of health care? Surely, anything is better than a “system” that leaves one-quarter of children and working-age adults uninsured. If one-quarter of us were homeless, for example, support for any reform would surely be close to universal.
Indeed, the data for homelessness helps clarify why we’re not in the panic about health care the establishment thinks we should be. It also helps us understand why scholars, the media, and the government are not giving us the information we really need to make good decisions on how to reform health insurance.
The National Alliance to End Homelessness reported last month that 671, 859 people experienced homelessness any given night in 2007. So how many people were homeless that year? It depends on the average spell of homelessness. If each person had been homeless for the whole year, then 671,859 people were homeless in 2007. However, if each person were homeless for only one night, then the total number of homeless people in 2007 was 245 million: about four-fifths of the population! The truth is somewhere in between.
The homeless advocates divide their constituents into “chronically” and “non-chronically” homeless. No such luck with those who survey the Golden State’s uninsured, which explains why the sound bite proclaiming one-quarter of Californians uninsured is misleading.
The UCLA scholars’ estimate of 8.2 million uninsured were “uninsured all or part of” 2009. A 2003 report by the Congressional Budget Office makes clear a rapid “cycling” of people through health insurance. If we look only at people uninsured for the month of March, 1998, 8 percent were uninsured for four months or less, 14 percent were uninsured for five to 12 months, and 78 percent were uninsured for more than 12 months. However, if you look at people uninsured for some time during the whole 12 months of July 1996 through June 1997, 45 percent were uninsured for four months or less.
The current recession is undoubtedly causing people to lose health coverage. However, whether these spells of uninsurance will be longer or shorter than the historical average remains to be seen. Another major problem is more epistemological: Health policy scholars insist on categorizing those on state welfare programs, such as Medi-Cal or Healthy Families, as “insured,” rather than uninsured. This results in a bias towards more government dependency.
Unemployed Californians are eligible for CalWORKs assistance as cash, but we’d never categorize people who receive these welfare payments as “employed.” Similarly, we’d never say that homeless people in a temporary shelter are no longer homeless.
Categorizing people dependent on Medi-Cal and Healthy Families as “insured” hides the truly destructive consequences of these programs to families’ self-reliance. The same UCLA survey suggests that the kids are alright because only 13 percent of children were “uninsured” for all or part of 2009.
But this disguises the reality that the share of California kids with private health insurance dropped from 58 percent in 2001 to 51 percent in 2009, while the proportion on Medi-Cal or Healthy Families climbed by almost the same amount up to 32 percent. The percentage uninsured barely budged. Instead, the growth of government merely crowded out privately chosen health insurance.
Even worse, most of this occurred during good economic times. From 2001 through 2007, California’s unemployment rate dropped from 6.4 percent to 5.8 percent. Nevertheless, the share of kids dependent on government welfare for medical services increased from 24 percent to 29 percent.
Defining and measuring the “uninsured” is critical to good health policy. Unfortunately, the way we do it in California leads only to relentless expansion of government, instead of more individual control of access to health care.