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The moderators kicked off the third Democratic debate with health care, teeing up another round of the ongoing "Medicare for All" debate.
Vermont Sen. Bernie Sanders caught our attention by claiming that 50 million people lose their private insurance every year due to employment changes.
"George, you talked about, was it 150 million people on private insurance? 50 million of those people lose their private insurance every year when they quit their jobs or they go unemployed or their employer changes their insurance policy," Sanders said.
That sounds like a huge number even before he qualified it by attributing it to job loss and other work-related occasions for an insurance lapse.
We reached out to the Sanders’ campaign to find out the basis for this claim, and they pointed to an analysis by the People’s Policy Project, a social democratic-leaning think-tank. That analysis hinges on a question asked as part of a national Centers for Disease Control and Prevention survey in 2014, plus a little basic multiplication.
The survey asked adults between the ages of 18 and 64, in 43 states: "In the PAST 12 MONTHS was there any time when you did NOT have ANY health insurance or coverage?" In response, 12.9% said they had experienced a gap in coverage, while 11.5% said they had been uninsured for more than 12 months.
The think-tank analysis then combined those percentages and multiplied them by current population estimates, coming up with "just under 50 million people" who were uninsured for at least part of the year. (It went on to endorse "Medicare for All.")
This claim becomes perplexing when you consider the total number of uninsured people in recent years. In 2013, there were more than 44 million uninsured, non-elderly Americans in total. With the initial implementation of the Affordable Care Act, that number steadily declined until last year when it ticked up slightly to 27.5 million.
A Sanders spokeswoman also cited another People’s Policy Project blog post analyzing the number of people who leave their jobs (66.1 million in 2018, it said) and government data on the number of jobs the average worker has had by age 50 (11.9).
The campaign specifically pointed to this sentence in the blog post: "This labor turnover data leaves little doubt that people with employer-sponsored insurance are losing that insurance constantly, as are their spouses and kids."
The CDC data is compelling, to be sure — but Sanders did not accurately portray what it said on the debate stage, nor did he accurately portray the policy analysis his campaign claimed was his source.
Sanders appears to suggest that one-third of those with private insurance are uninsured for at least a short time every year because of a change to their employment benefits.
In actuality, the CDC data show that about 24.4% of non-elderly adults in 2014 had experienced at least a gap in insurance coverage in the previous year. The question did not ask respondents to specify the cause.
The age of the report also poses a challenge: The Affordable Care Act’s Medicaid expansion began in 2014, and the report surveyed just 23 Medicaid expansion states at the time. Today, 37 states and the District of Columbia have expanded Medicaid, suggesting the number of people with insurance gaps on an annual basis could have dropped.
And the People’s Policy Project analysis actually refers broadly to 50 million non-elderly Americans who were uninsured, temporarily or otherwise -- it doesn’t say those people were uninsured because their job situation changed.
Sanders said that 50 million of those people lose their private insurance every year "when they quit their jobs or they go unemployed or their employer changes their insurance policy."
Sanders has a point that coverage continuity is a big problem in a country where roughly 150 million get their insurance from their jobs. But his claim inflates the scope of the problem].
He took a broad finding about the number of people who had experienced an insurance gap for any reason roughly five years ago and misleadingly used it to describe a much narrower segment of the current population who lost insurance because of employment changes.
The claim has an element of truth but leaves out critical information that would give a different impression. We rate the statement Mostly False.
Email interview with Sanders' spokeswoman Sarah Ford, Sept. 12.
People's Policy Project, 50 Million Adults Are Uninsured Every Single Year, July 2, 2019.
Centers for Disease Control and Prevention, Surveillance for Health Care Access and Health Services Use, Adults Aged 18–64 Years — Behavioral Risk Factor Surveillance System, United States, 2014, February 24, 2017.
Kaiser Family Foundation, Key Facts about the Uninsured Population, December 7, 2018.
U.S. Census Bureau, Income, Poverty, and Health Insurance: 2018, September 2019.
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