Underinsured and uninsured patients. Who are they, and how can they be covered?

Whether 31 million or 37 million, the number of Americans who are either partially or completely without medical insurance is far too high, and may well be growing. Explanations include the recession of the early 1980s, the change from a manufacturing to a service-related US economy, and health care cost-containment pressures. The total uninsured population comprises three main groups: the indigent (around 25%), the medically uninsurable (0.5%), and the working uninsured (the largest, at roughly 75%). Providing coverage may require different strategies for each group. Proposals range from a subsidized risk pool to Medicaid reform to a combined subsidy-plus-voucher system. A Medicaid buy-in plan could help fill the gap between 100% employer-provided coverage and zero individual coverage.