The answer is yes. Twenty-five percent of the uninsured are already eligible but have failed to enroll in existing state-federal health coverage under Medicaid, for very low-income parents, pregnant women and people with disabilities, or the State Children's Health Insurance Program, or SCHIP, for children, according to studies, including one in 2007 by the nonpartisan Kaiser Family Foundation.
Different studies use different figures that fluctuate year by year. But based on the 46 million U.S. Census Bureau estimate, removing those people already eligible for free care would knock the figure down to around 34.5 million.
But that figure includes illegal immigrants. Although they have health-care needs, they would not be eligible for federal subsidies under overhaul proposals by President Barack Obama and members of Congress.
Widely varying figures have been reported for the number of illegal immigrants. The census says "noncitizens" account for 9.7 million people. But not all of them are illegal, since that number includes people awaiting a green card or citizenship test and who comply with immigration laws. The Pew Hispanic Center has estimated that 6.8 million people without health insurance were in the United States illegally in 2007. Other figures have put it at 8 million. Using the Pew figure while also subtracting citizens who are already eligible for federal and state programs, the 46 million total now would come down to around 27.7 million.
Can those 27.7 million people afford insurance?
This is where opinions diverge further, because of differing assumptions about the lives of people who don't get employer-provided health insurance and don't buy it themselves. Kaiser figures, which precede the recent economic downturn, show that about 56 percent of this group makes too much money for free health care but earns too little to afford an insurance policy. Kaiser put insurance affordability at 300 percent of the poverty level. The poverty level currently is $10,830 for a single person, or $22,050 for a family of four.
The Employment Policies Institute, a conservative-leaning nonprofit organization, says that about 43 percent of adults under age 65 earn 2.5 times the federal poverty level, "indicating they likely have the means to obtain health-care coverage and thus may be classified as 'voluntarily' uninsured.'Â¤" But Len Nichols, a health-care economist at the New America Foundation, a centrist think tank, says that a mother with two children, earning three times the federal poverty rate, would have to spend 24 percent of her income for an average health-care policy unless her employer picked up some of the cost.
But we're not done with the math yet. Nearly 30 percent of the 46 million figure that is often cited represents young adults between 18 and 24, according to the census. Reasons for their uninsured status are not tracked with precision. While some are too old to be eligible for their parents' policies but still are underemployed or unemployed, policy makers and politicians also assume that some are simply cocky about their chances of needing care and prefer to save or spend money on other things. But hard data on that point, too, are divergent, and debate on just what is affordable shows wide disagreement.
Within all these numbers is the broader debate: What would happen if the majority of these 46 million people -- or 34 million or 27.7 million -- became insured? Would it be smart of the government to reorder the health insurance system so that almost everyone had coverage?
The Obama administration and many health-care advocates say yes, noting that premiums from younger, healthier people would cross-pollinate with the premiums of others, reducing costs for everyone. And by providing routine health care for the poor, rather than waiting for them to show up in emergency rooms where they sign up for Medicaid or SCHIP, the country could improve its health as well as its economy.
How to do this is where the real policy disagreements lie.
"There is something to the argument" of wanting to bring younger, healthier people "into the insurance pool," said Michael Tanner, a senior fellow at the Cato Institute, a libertarian think tank. "The question is, what is the best way to get them in there." He doesn't believe the Democrats' plan, which could cost $1 trillion or more, is the way. Tanner prefers to bring down costs and premiums through market-based solutions, less regulation and fewer mandates.
He, too, studies the numbers. And although he comes at it from a different perspective from Kaiser, he too notes that a quarter of the uninsured already qualify for government coverage.
"If you show up at the emergency room and you are not enrolled already, they'll get you signed up," Tanner said of the roughly 12 million people who already qualify. "Hospitals, after all, want to get paid."