You hear or read the number all the time. The New York Times breathlessly reports there are 46 million uninsured Americans and President Barack Obama routinely asserts the same number. The Census Bureau estimates, however, do not tell the entire story. The uninsured are a diverse and dynamic population, and the higher frequency of coverage loss is not only a function of the recession, but of the flaws inherent in the health insurance markets, namely the inability of individuals and families to secure and maintain personal and portable coverage. Data released by the Agency for Healthcare Research and Quality (AHRQ) and Centers for Disease Control and Prevention (CDC) enables taxpayers to drill deeper into the problem.

The AHRQ data reaffirms there are gaps in coverage. There is nothing new here; it is the problem that conservative health policy analysts have been trying to address for the last two decades. It is a structural problem in the insurance markets. While the millions who lose and gain coverage- the source of middle class anxiety- is not much different now than it was in the last ten years or more, it is well to remember that the number of Americans who are poor, sick, and uninsured for a lengthy period is a relatively small number, about 4 million individuals. This is problem is not hard to resolve.

What Congress should focus on, then, is how to make health insurance personal and portable; something moderates and conservatives in Congress, based on their own legislative proposals, know exactly how to do. Instead what we are getting is just an acceleration of the already fast tracked government control of health care.

Take the SCHIP data from AHRQ. There were 5.9 million uninsured children in 1999. In 2007, there were still 5.9 million uninsured children (Statistical Brief #259). Public coverage went up, and private coverage went down; but overall, coverage remained the same. Consider that the cumulative cost of SCHIP and increased Medicaid enrollment of children has exceeded $100 billion. The data suggests that much of this spending has simply substituted taxpayer dollars for private dollars. It’s called crowd out, and it is profoundly irresponsible public policy. For every two dollars of spending, you get a $1 worth of coverage. This is likely to be repeated if Congress enacts the same, tired, old formula: expansion of public programs. Neither the Administration nor Congress has yet to explain how much of the $1.2 trillion in new spending under the House legislation will go to simply replacing private spending with taxpayer dollars.