The Dynamics of the Uninsured: Finding Ways to Cover an Ever-Changing Population

The number of uninsured Americans is one important measure of how serious a problem the lack of health coverage is. But counting the uninsured is harder than it sounds. While Census Bureau estimates of the uninsured are the most widely quoted (41.3 million in 2001), Americans who lack health insurance are a constantly changing group. They may lose coverage when they are laid off, shift employers, no longer qualify for public insurance programs or go through divorce or the death of a covered spouse. Then many regain it.

The period of uninsurance makes a big difference in the numbers. According to a recent Congressional Budget Office analysis, the number of uninsured ranges from 21-31 million—those who lacked insurance for all of 1998—to 57-59 million who lacked coverage for some significant period during that year.

When people become uninsured, how long do they go without coverage? Why do they remain uninsured? Are there negative effects to short periods of uninsurance? What are the private and public sectors doing to help people hang onto coverage? What does the dynamic nature of the uninsured tell us about how to target policy solutions to this large and growing population?

To help address these questions, the Alliance for Health Reform and the Kaiser Commission on Medicaid and the Uninsured sponsored a March 21, 2003 briefing. Panelists were: Pamela Farley Short of Pennsylvania State University, John Holahan of the Urban Institute and John Czajka of Mathematica Policy Research. Catherine Hoffman of the Kaiser Commission on Medicaid and the Uninsured provided opening remarks and Ed Howard of the Alliance moderated the discussion.