President Obama and fellow Democrats are throwing around a big number in the health care debate — the number of people living in this country without health insurance.
"We are not a nation that accepts nearly 46 million uninsured men, women and children," President Obama told doctors in a speech before the American Medical Association in Chicago in June. "We are not a nation that lets hardworking families go without coverage, or turns its back on those in need. We're a nation that cares for its citizens. We look out for one another. That's what makes us the United States of America. We need to get this done."
And the White House Council of Economic Advisers pressed the number in its number-crunching case for a health overhaul: "Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance," according to the report, also issued in June.
The 46 million number is a handy one — large and round — but who are the people it represents, and what does it mean for the rest of us that they don't have insurance?
They may not be who you think they are.
Let's start by putting that number into context: 46 million is as big as an entire generation of people born between the late 1960s and the early 1980s who grew up on Ronald Reagan, neon jelly bracelets and MTV. That would be Generation X.
Size-wise, it's roughly 15 percent of the U.S. population.
The estimated number of uninsured — technically 45.7 million — comes from 2007 Census Bureau estimates. These are the latest official numbers available, but because Census only asks who was uninsured at any given time during the year, the number is quite fluid.
Although the number of uninsured has grown slowly in the past several years, it's speeding up, mainly because employment has declined drastically since the Census report. And most of us get our insurance through our jobs.
The new Census numbers come out in September, and experts say the numbers are likely to be higher because of job loss.
Who Are The Uninsured?
Contrary to popular belief, most of the uninsured are working families. They tend to be poorer and in worse health than those with insurance, according to the nonpartisan Kaiser Family Foundation.
"About 70 percent are from families with one or more full-time workers," Kaiser says in a report on the uninsured issued late last year.
And some 40 percent of the uninsured are between the ages of 19 and 29. While there is heated speculation that many of these young people don't buy insurance because they are healthy and don't want to, the evidence suggests that they are actually less likely to be able to afford insurance.
"Young adults have the highest uninsured rate (30 percent) of any age group. More than half of uninsured young adults are full-time workers, but their low incomes make it more difficult for them to afford coverage," according to the Kaiser report.
But not everyone agrees that 46 million is the right number.
A conservative media watchdog, the Media Research Center, accuses the media of hyping the number of uninsured in order to frighten the public and "bolster calls for universal government-run insurance coverage."
Part of the argument against using the 46 million number is that a few million of them are likely enrolled in Medicaid but tell the Census that they are uninsured because they don't have private insurance — the so-called Medicaid undercount.
Also, almost one in five of the uninsured are not citizens of the United States. About half of that group — some 5 million or so — are undocumented. Whether legal immigrants should be included in expanded coverage is a matter of debate, but none of the plans being considered by Congress covers illegal immigrants.
Massachusetts, the first state to pass universal health insurance, is backtracking on its pledge, cutting subsidies to legal immigrants.
"Liberals can argue that we still have a moral duty to cover noncitizens, but this doesn't change the fact that as a matter of accuracy, the Census data only tells us that 36 million Americans are uninsured," The American Spectator's Philip Klein wrote in the March issue.
Another challenge is getting people who are already eligible for existing federal health plans like Medicaid and the state Children's Health Insurance Program to sign up.
Of the estimated 46 million uninsured people living in the United States, about one-quarter of them are eligible for these programs but not enrolled.
Either they don't know about the programs, they are unsure of their eligibility, or they live in states where such programs are already maxed out.
If all who are eligible sign up, that could knock a big chunk out of that 46 million uninsured number. But how to make that happen remains an inexact science. The various health overhaul bills now being discussed on Capitol Hill seek to boost the number who sign up.
So, are there really 46 million uninsured? It's the current best guess, but it might be off by several million.
What Does It Mean?
Whatever the exact figure, tens of millions of people don't have insurance. But that doesn't mean they don't cost money. In fact, they may cost more.
"The barriers the uninsured face in getting the care that they need means they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance," according to the Kaiser Family Foundation report.
And that's a challenge for us all.