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The Issues That Matter |
Health InsuranceWhat Is The Nature Of The Problem?How big is the problem of uninsured Idahoans? A website sponsored by the Robert Wood Johnson Foundation, which wants everyone covered, claims that the 2006 Current Population Survey data indicates that 14.7% of Idahoans are uninsured. That's actually better than the national average (although not by much). Here's a report put together by Mathematica Policy Research for the Joint Legislative Oversight Committee last year. It estimates that 16-18% of the "non-elderly population" of Idaho was uninsured as of 2005. (People over 65 are covered by Medicare; hence the discrepancy with the 14.7% figure.) Characteristics of the uninsured are unsurprising: the 18-24 and 25-34 populations seem to be especially prone to being uninsured, while only 10% of the 0-17 population are uninsured. This is probably, at least in part, because large numbers of Idahoans graduate either high school (and don't go on to college) or graduate college, and lose eligibility under their parents health insurance plan. While no report gives a breakdown of illegal immigrants versus legal residents, the combination of low pay and lack of knowledge of our system means that illegal immigrants in California are disproportionately uninsured. I would be surprised if that is not the case in Idaho as well. Fixing the illegal immigrant problem would certainly make some progress on fixing this problem, too, both by encouraging illegal immigrants to leave Idaho, and because doing so would drive up the wages of legal workers who compete with illegal immigrants for low-paying jobs. We should not overemphasize the part that illegal immigrants play in this problem. Federation for American Immigration Reform (an advocacy group) estimated in 2007 that there were about 35,000 illegal aliens in Idaho. Even if none of them were insured (which seems unlikely), this would be, at most, about one-seventh of Idaho's uninsured population. I'm not thrilled that 10% of the 0-17 population are uninsured, but that also means that 90% of children are insured, either privately, or through governmental insurance programs such as Medicaid or SCHIP. Why are there Idahoans who are uninsured? I was uninsured for a few months, back when I was 19 years old, mostly because I wasn't thinking about it. I worked for an employment agency with no benefits. I just never thought about the need for health insurance--I was in good health, and seldom saw the doctor. After a few months, I did start to think about it, and I went out and bought individual health insurance that covered just hospitalization. I figured that I would pay everything else out of pocket. It made the cost of coverage a lot more reasonable. I'm guessing that many of Idaho's uninsured are in that situation because of poverty. The statistics in that Mathematica Policy Research study shows that 45,000 adults with incomes below $15,000 per year were uninsured--or 49% of that income group. I would expect that most of these couldn't afford health insurance, and were too well off to qualify for Medicaid. Ditto for the roughly 70,000 uninsured adults with incomes in the $15,000 to $25,000 per year range (48% of this income range). When I looked into this last year (when I was considering retiring), I found that a basic individual health insurance policy will cost about $300 to $400 a month for an adult, with deductibles in the $2500 per year range. You should consider such a plan to be coverage for serious things that go wrong--and you will be paying for your prescriptions and office visits. I'm told that if you can tolerate a $9000 per year deductible, you can get coverage for $99 per month (at least in some parts of Idaho). Still, while much of the under $25,000 per year group may not be able to afford health insurance, there are still uninsured adults making more than $50,000 a year. Not as many, or as high a percentage--but whatever is causing 4% of people in this income bracket to be uninsured, poverty isn't likely the reason. That's a net income of at least $3000 per month. You can afford to buy health insurance with that kind of income--and if you can't, that's a foolishness problem, not a poverty problem. Much of the uninsured problem seems to be with unemployed people, those living in rural areas, and working for small employers. Of employers with less than 10 employees, only a bit more than 30% offer health insurance to their employees. Part-time employees, also unsurprisingly, are disproportionately uninsured. Most group health insurance plans are only available to full-time employees (either 30 or 32 hours per week, depending on the plan). SolutionsWhat can Idaho government do? I'm still scratching my head about this, but I can see several possible solutions:
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