By Tom Curry National affairs writer
msnbc.com
updated 8/31/2009 4:32:37 PM ET 2009-08-31T20:32:37

Claim:  About 20 percent of those people who are uninsured could buy their own coverage but don't.

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According to the most recent Census estimate, nearly 46 million people were without insurance in 2007. The number of uninsured has almost surely increased since then due to the recession. The bills offered by Democrats would require that uninsured people obtain insurance, with penalties on those who went uninsured and subsidies for lower-income people. But critics question whether the uninsured problem is exaggerated.

Is it fact or fiction?
Unclear. In 2007, about 10 percent of the uninsured had family incomes above $82,600 for a family of four. Some would have been able to afford insurance, but it's uncertain how many.

Affordability not the only issue
Some who could afford insurance may have been barred by pre-existing medical conditions or, if their employer didn't offer insurance, may have found policies in the non-group market too costly for the limited services that were covered.

Why some go uninsured
According to Paul Fronstin at the Employment Benefit Research Institute, the uninsured are, on average, younger and healthier than the general population. About 30 percent of the uninsured are between ages 19 and 29. MIT health care economist Jonathan Gruber said, "individuals may not be willing to purchase insurance if their medical risks are primarily catastrophic," because they know they can get emergency room care.

The individual mandate
It's exactly because some of the healthy go uninsured that the Democrats' insurance overhaul includes the individual mandate, forcing people to buy insurance. This would improve risk pools. Said Urban Institute economist Linda Blumberg , "You're bringing in higher-income people who aren't going to be subsidized and you're bringing in the people who are healthier and didn't expect to use medical care."

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