Insuring the Uninsured: Will the 2004 Election Provide an Answer?

A June 2004 report revealed startling new statistics on uninsured Americans (1). A total of 82 million Americans—1 of 3 people younger than 65 years of age—were uninsured at some point during 2002–2003 (1). Conducted by the well-regarded Lewin Group, the study found that two thirds of the 82 million were uninsured for 6 months or more, with half lacking coverage for at least 9 months. These figures, based on U.S. Census Bureau Current Population Survey data, are far higher than the commonly cited number of 43.6 million uninsured for the entire calendar year 2002 (2).

Despite these findings, proposals to expand health insurance rarely grace headlines about the 2004 presidential election, crowded out by concerns over jobs and Iraq. Even in the health care penumbra, other issues command more attention. Controversy swirls around the 2003 Medicare Modernization Act. Drug reimportation from Canada is high on the wish list of seniors and of governors—Republican and Democrat—concerned with Medicaid pharmacy costs. Embryonic stem-cell research and abortion rights are on constituents' minds. Physicians want legislative action to control malpractice premiums.

Recent polls indicate that most Americans desire a government guarantee that people receive coverage for basic health care services, but far fewer people are willing to pay more taxes to insure the uninsured. The polling data suggest that the climate for expanding health insurance is less favorable than it was 10 years ago (3). According to analyst Jonathan Oberlander, “The most relevant political fact about U.S. health politics is not that 15 percent of the population is uninsured but that 85 percent is insured” (4).

Responding to voters' lack of enthusiasm to pay for expanded health care coverage, politicians from both parties have changed their view on how to insure the uninsured. In the past, many health …