Wednesday, August 21, 2013

Exercising their rights

One of the more unpopular aspects of "Obamacare" has been its requirement that people buy health care insurance.  I always assumed that, even among people who fervently support the right to go without health coverage, few want to exercise that right.   But I've never seen any estimates of the number of voluntary uninsured, so I used the 2009 Behavioral Risk Factors Surveillance System data to explore the issue.  I defined a group who (a) rated their health as excellent or very good, (b) earned at least $35,000 per year and (c) said "no" when asked if there was "a time in the past 12 months when you needed to see a doctor but could not because of cost."  These are people who presumably don't have substantial regular health care costs and have the resources to pay for the care that they need.

In the BRFSS sample, about 10% are uninsured and 10% of the uninsured have this combination of characteristics.  So the "potentially voluntary" uninsured make up about 1% of the total population.  Who are they?  Compared to the rest of the population, they are more likely to be self-employed, younger, male, and single.  These patterns aren't surprising.  But they are also more likely to be unemployed (10.7% were unemployed compared to 5.6% among everyone else).  They were also quite a bit more likely to have children under 18 (43% vs. 28%). Putting these together, it seems that at least half of this 1% would like to have health insurance but can't afford it.  


  1. That strikes me as a very restrictive definition of "voluntary." Someone who spends their disposable income - or prioritizes their non-disposable income - on many items other than health "insurance" (a phrase that as generally used really means health coverage) has in more than an abstract sense made a choice to do so, and should be included in the category of voluntarily uninsured.

    For example, some people who answered "yes" to question (c) may own a cell phone (perhaps even a smart phone), a car or clothes or electronics that are more expensive than simple functionality requires; may spend money on movies or fast food; etc. It's not obvious to me that those people should be classified as involuntarily uninsured.

  2. True, it's hard to draw an exact line between voluntary and involuntary, especially without knowing much about individual circumstances. My main point that even among the relatively affluent and healthy uninsured, the demographic profile suggests that they're not just people with a high tolerance for risk: financial reasons are likely to be important.