The problem of the uninsured

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.