facts and nonpartisan perspectives on the issues

The Uninsured

Likely voters consistently rank health care as one of the top three issues at stake in the 2008 election, and the candidates competing for the White House have taken notice. Nearly every major candidate has a detailed plan for improving health insurance access and affordability, with proposals ranging from expanding public programs to paring back regulations on private-market insurance plans.

The Urban Institute's Health Policy Center is home to leading experts on the uninsured. UI researchers offer analysis and perspective on the problem of uninsurance and potential solutions.

KEY FACTS

• The number of uninsured in the United States reached 47 million in 2006, rising by 8.7 million between 2000 and 2006.
• Of the 47 million uninsured, 9.4 million uninsured were children, 37 million were adults between 19 and 64, and half a million were older than 65.
• Most uninsured—70 percent—are in families with a least one full-time worker; only 18 percent are in households with no worker.
• Noncitizens—legal and illegal—account for 22 percent of the uninsured, despite being only 8 percent of the population.
• Almost all of the growth in the number of uninsured between 2000 and 2006 was among adults, and the primary reason for the growth was the drop in employer-sponsored insurance.
• Coverage through employers has declined consistently over the last decade. Rapidly rising premiums have outstripped many employers' budgets for providing health plans and many workers' ability to pay their shares of the premiums.
• Proposals that require either employers or individuals to secure insurance can boost coverage rates, but they risk opposition from business (in the case of employer mandates) and they need provisions for affordable insurance (in the case of individual mandates) to be fully effective.
• Tax-credit proposals can also expand coverage but are limited in their ability to improve access for low-income people or those with existing health problems.

Additional analysis is available in UI reports:

• What Happened to Health Insurance Coverage of Children and Adults in 2006?, John Holahan and Allison Cook
• Why Do People Lack Health Insurance?, John Graves and Sharon Long
• Increasing Health Insurance Coverage of Workers in Small Firms: Challenges and Strategies, testimony before the Senate Finance Committee by Linda J. Blumberg

Decision Points '08 is published weekly by the Urban Institute, a nonpartisan social and economic research organization.
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