Who Are Ohio’s Uninsured?
Reading any news article on health care, you often see citation that over a million Ohioans are uninsured. Many commentators and politicians, citing this number, say it is a crisis that needs immediate government intervention. But what is often unexamined is who exactly lacks insurance. Once you start to look at the true face of Ohio’s uninsured, the idea that this is somehow a crisis is not a reality. Usually in discussions regarding the uninsured, the storyline features poor people who want insurance but cannot afford it and as a result their health suffers. News stories routinely involve a family living in poverty and chronicle how their lack of health insurance led to a medical problem getting out of hand or bankrupting them. These stories then talk about how over a million Ohioans lack health insurance. The impression left is that all uninsured are in a similar situation. While there are certainly a good number of poor people among the uninsured, what is left largely unexplored is the fact that a large portion of the uninsured choose to go without insurance. And, in fact, it is likely that a majority of the uninsured are only uninsured for a few months. The people who choose to go without insurance or who are between insurance plans do not fit the media stereotype, but they fill the ranks of the uninsured in far greater numbers than do the families living in poverty who want insurance but cannot afford it. Who would choose to go without insurance? The simple answer is that those who do not see a value in health insurance choose to forgo purchasing a policy. People who are in good health and do not see any reason to pay a monthly premium for a policy they are unlikely to use may make a choice to use their money elsewhere. Young adults in Ohio, the healthiest segment of the population, are uninsured at rates over twice as high as other segments of the population. People with money also choose to forgo insurance. Almost one-third of Ohioans who are uninsured make incomes at twice the federal poverty level. Sixteen percent of the uninsured have incomes at three hundred percent of the federal poverty level. It is likely that the vast majority of these people, if they really wanted insurance, could afford it. Surprisingly, the poor also choose to go without insurance. In Ohio, the state offers Medicaid to any child living in a family below 200% of the federal poverty level. Many families choose not to sign up for this program, however. According to the Kaiser Family Foundation, roughly 71% of Ohio’s uninsured children are eligible for Medicaid but are not signed up for the program. The Governor is using the large number of uninsured children in the state to push for an expansion of Medicaid. As these numbers clearly show, though, most of the children are already eligible for Medicaid, they are just not using it. As can be seen, there are a lot of people who choose, for whatever reason, not to have health insurance. There are also a large number of people who are uninsured only for a few months out of the year. This is likely due in part to the fact that our health insurance system is largely tied to employment status. If you change a job, you typically experience a month or two before you enroll in your new employer’s health plan. The Congressional Budget Office estimated in 2003 that up to two-thirds of the uninsured were only without coverage for part of the year. In most surveys, however, these people are counted as “uninsured.” As is clear once you look at the numbers, the uninsured are a diverse group. While there are certainly many Ohioans who want insurance but cannot afford it, there are more Ohioans who choose to go without insurance or who are only uninsured for a short period of time. It is irresponsible for politicians and the media to use the idea of a monolithic “uninsured” to push for increased spending on government health programs. The real picture of the uninsured shows that all the talk of a “crisis” is empty rhetoric.
Marc Kilmer is a policy analyst with the Buckeye Institute for Public Policy Solutions, a research and educational institute located in Columbus, Ohio.
