As my colleagues Steve Bettison and Tom Papworth have pointed out in previous blogs, the frequently quoted figure of 46 million uninsured Americans is something of a myth. To restate some salient facts:

  • 9.7 million of these uninsured are not US citizens.
  • 14 million of them are eligible for the government programmes Medicaid or SCHIP, but not registered. If they ever presented at an 'emergency room' they would be signed up.
  • 17.6 million of those without insurance earn more than $50,000 per year. 10 million of them earn more than $75,000. That means that around 38 percent of the uninsured probably make enough to afford health insurance, but for some reason choose not to buy it.
  • 18.3 million of the uninsured are under 34. Many of those may simply think, mistakenly or otherwise, that they do not need health insurance.

It is also worth pointed out once again that the 46 million figure does not mean that 46 million people are permanently without insurance. Indeed, it is estimated that 10-20 million are only temporarily without coverage. In many instances, that could be because the US tax system creates huge distortions in favour of employment-based health insurance – something which causes problems when people switch jobs.

Clearly, some people will fall into more than one of the categories I've outlined, so you can't you can't just subtract all of those numbers from 46 million to give you a fair figure. However, most people seem to think that 10 million or thereabouts would be an accurate reflection of reality. Back in 2003, a Blue Cross survey found the 8.2 million Americans were actually without health coverage in the long run because they are too poor to afford private insurance but earn too much to get government assistance.

Quite plainly, that is still a problem, but it is not a problem that suggests huge government intervention is needed (which is probably why President Obama prefers the 46 million figure). Interestingly, research from the University of Minnesota has suggested that if the US government simply permitted its citizens to purchase health insurance across state lines, 12 million more people would be able to afford insurance.