The Problem of the Uninsured

Isaac Ehrlich, Yong Yin

NBER Working Paper No. 18444
Issued in October 2012
NBER Program(s):   HE   AG

The problem of the uninsured – those eschewing the purchase of health insurance policies – cannot be fully understood without considering informal alternatives to market insurance called “self-insurance” and “self-protection”, including the publicly and charitably-financed safety-net health care system. This paper tackles the problem of the uninsured by formulating a “full-insurance” paradigm that includes all 4 measures of insurance as interacting components, and analyzing their interdependencies. We apply both a baseline and extended versions of the model through calibrated simulations to estimate the degree to which these non-market alternatives can account for the fraction of the non-elderly adults who are uninsured, and estimate their behavioral and policy ramifications. Our results indicate that policy analyses that do not consider the role of self-efforts to avoid health losses can grossly distort the success of the ACA mandate to insure the uninsured and to improve the health and welfare outcomes of the previously uninsured.

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Acknowledgments

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