A new report examines who lacks health insurance and some of the reasons why they do.

The report gives some why's, but, of course, it never asks the big why:

Why, when such a huge percentage of health insurance is subsidized or directly paid for by our taxes, don't we just go all the way and do the right and humane thing and just cover everyone for less?

A new study is out on health insurance coverage - Lisa Dubay, John Holahan, and Allison Cook, The Uninsured And The Affordability Of Health Insurance Coverage - Examining subgroups of uninsured Americans uncovers certain patterns of coverage gaps, but affordability remains a key concern.

The study notes that the number of uninsured has exploded in the past five years: "The number of uninsured Americans increased by more than six million, rising from 39.6 million in 2000 to 46.1 million (nonelderly) in 2005." This is a serious problem with many dimensions.

Those who are uninsured have worse health than those who are covered. They also use health care less than those who are insured, despite needing more healthcare.

Those who lack health coverage are more likely to be pushed into bankruptcy by medical expenses.

The lack of coverage and lack of assets shifts the costs to hospitals, doctors, or others who provide health care and then onto other institutions, such as local governments and "philanthropies that support them."

Most health insurance comes from employers. Employers provide health insurance coverage for 161 million nonelderly people.

Another 30 million are covered by programs such as Medicaid and the State Children's Health Insurance Program (SCHIP).

Fourteen million buy their own health insurance. Medicare and military health insurance programs also provide coverage.

This patchwork of coverage leaves 45.5 million nonelderly Americans with no health coverage.

Why are people uninsured?
The study finds that there are three main groups who lack health insurance.

1. People who are eligible for Medicaid and SCHIP but do not participate. The reasons include: "administrative barriers, limited outreach efforts, or lack of knowledge about eligibility for public health insurance coverage, or because families themselves do not make the necessary efforts to obtain coverage."

2. Those with enough income that they are not eligible for Medicaid or SCHIP, but who cannot afford to pay for health insurance. The study noted: "Health insurance premiums have risen dramatically in recent years: Premiums for private-sector employees of all firm sizes averaged about $3,700 for individuals and $10,000 for families in 2004." As a result, many employers drop insurance coverage or decide to shift cost increases to their workers. In addition, many workers are not eligible for coverage by their employers. These include probationary, part time, and seasonal employees.

3. Finally, some have higher income but are not eligible for employer plans. Their only recourse is to pay individual premiums, which are very high. A large number in this group are self-insured. Others are denied coverage, often because they have poor health.

Each of these situations calls for different remedies. The study examines options and data with great care.

Of course, the real question is why we put up with this complex system that denies health care to so many and drives people into bankruptcy.

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