Progress Illinois

When it comes to the health care refom debate, GOP Rep. John Shimkus thinks liberals are using disingenuous figures to describe the size of the nation's uninsured population. "Forty-five million [people] sounds worse than than 15 million," he said on Springfield talk radio station WMAY yesterday morning. When asked where he got the 15 million figure, he cited a recent New York Times editorial that attempts to break down the unemployed population. Unfortunately, Shimkus didn't read the paper too carefully.

Here's his first oversimplication:

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SHIMKUS: One-third [of the 46 million uninsured] are people as you say that are either young adults in the job market they feel they are never going to get sick so they’re not purchasing. And the other part of that third are folks who make on average $75,000 a year or $88,000 for a family of four who could afford the private insurance market but they are making the decision not to do it. That’s one-third.

The Times cites census data showing that 9 million (19 percent of the uninsured) come from households with incomes of $75,000 or more. But the paper also recognizes that "many of these people live in 'households; that are groups of low-wage roommates or extended families living together." In other words, despite their aggregate household income, many lack the resources to purchase insurance on the open market. Only 4.7 million (10 percent) live in families that earn $88,000 for a family of four, which experts consider the threshold of affordability.

Of the 13 million people (28 percent) in their 20s living without insurance, the Kaiser Foundation also found that just 10 percent are college graduates and 5 percent have incomes above $60,000 a year. "Many of these younger people," the Times writes, "would be helped by reform bills that would provide subsidized coverage for the poor and an exchange where individuals can buy cheaper insurance than is now available." 

But you probably won't hear Shimkus citing that conclusion any time soon.

Here's his subsequent embellishment:

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SHIMKUS: One-third are folks that will qualify for current federal programs, okay? So they could be on Medicaid and they usually will get enrolled when they go in but they are not enrolled right now. So that’s another third.

Shimkus is correct that many Americans do qualify for existing federal programs but are not enrolled. Yet the Times says that figure is just about 11 million, making up 24 percent of the total uninsured population.  The editorial also notes the following:

When such people arrive at an emergency room, they are usually enrolled in Medicaid, but meanwhile they have lost out on routine care that could have kept them out of the emergency room. They will presumably be scooped up by the mandate under reform bills that everyone obtain health insurance.

And here's point three:

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SHIMKUS: So the final third – 15 million – who are they? Ten are probably the working poor -- minimum wage, couple bucks over that, the employer can’t cover. We can help those. The other portion of those – maybe 8 to 10 million -- are illegal immigrants and we have to address that debate.

Let's deal with undocumented immigrants, first. Both Shimkus and Rep. Mark Kirk claim between 8 and 10 million illegal immigrants are uninsured. While it's true that some 9.7 million "non-citizens" lack coverage, only 5.6 million (PDF) entered the country illegally. The rest, according to the National Institute for Health Care Management, are refugees, legal permanent residents (e.g., green card holders), or legal temporary residents. The Times makes a similar distinction.

Shimkus also mischaracterizes the size of the public option towards the end of the interview. "If the issue is getting insurance to the individuals who do not have insurance," he asks rhetorically, "then why does it have to be a government-run option? And we give them private insurance."

In fact, the public option would be housed in the Health Insurance Exchange, which will likely only be open to the unemployed, the self-employed, and businesses with 10 or fewer employees (the size of business could be expanded in the future). At most, 30 million people would be eligible to enroll in the government-run plan when it's first implemented. Undoubtedly, portions of that population will choose not to. But under the Democratic proposals, people earning between between 133 and 400 percent of the Federal Poverty Level would be provided government subsidies to purchase insurance on the private market. In fact, expanding Medicaid and providing subsides to the working poor and middle class are the bill's primary mechanisms for providing affordable access to the vast majority of Americans.

If approved by Congress, the public option will be one (valuable) choice available to individuals. But it's not the sole component of the reform effort, as Nicholas Beaudrot's great flowchart shows.