Perusing Health Affairs 25th Anniversary Issue, a couple of articles stand out. Here’s one: Higher Income And Uninsured: Common Or Rare? By Hanns Kuttner and Matthew S. Rutledge. Click here – but subscription required.
One of the accepted truisms in the MA health reform legislative debate was the existence of a significant number of uninsured who reside in higher income households — not a majority (as some purported), and not insignificant ~ 50-75,000 over 500-600% of the federal poverty line. And awareness of this number was a factor — not the only one, but definitely one — behind legislative acceptance of an individual mandate.
Now comes the Kuttner/Rutledge analysis throwing some cold water on this assertion:
Abstract: Massachusetts plans to penalize those who do not have health insurance, targeting higher-income people. Are higher-income Americans a small or substantial share of the uninsured? The U.S. Census Bureau reports that one in three Americans without health insurance lived in a household with income greater than $50,000 in 2005. Many of these higher-income uninsured people do not fit the profile of free-riders who have the money but are unwilling to buy coverage. A majority have lower incomes but live with others; only together are they higher income. For others, higher income or lack of insurance is transient.
A more diverse and transitional population than appreciated during the legislative debate. They challenge the notion there is a significant middle-upper middle class group who are conscientious objectors to health insurance.
