Parsing the number of uninsured

Jeffrey Lapides, PhD, a business consultant and physicist who writes Political Sunshine Government Sunshine, has posted an analysis that goes beyond the oft-quoted 40+ million people in the US without health insurance to estimate the number of people who want health insurance but can't get it. It's a useful analysis because it begins to help policymakers (and insurance companies) devise relevant approaches.Rather than relying on surveys of the uninsured Lapides uses bottom-up calculations to reach an estimate of about 42 million uninsured (lower than the 47 million we often hear, but he has his reasons). He then analyzes a variety of segments:

• Wealthy people who forgo insurance for whatever reason
• Young adults who choose not to buy
• Younger people in between jobs
• Older people in between jobs
• Those eligible for government programs such as Medicaid but unaware

Using data where available and some pretty good guesses where not, Lapides concludes that the number of people who want health insurance but can't get it is about 23 million, still a big number but quite different from the original figure.Another way to look at the number is the 19 million (=42 million - 23 million) who could get health insurance but choose not to. This is roughly the number of people who could be added to the insurance roles with an unsubsidized mandate and guaranteed issue.