Lost in Translation?

The Republican presidential candidates met Sunday evening in Florida for a forum hosted by the Spanish-language media company Univision Communications. We found a few missteps in what the candidates had to say to Spanish-speaking voters:

• Former Arkansas Gov. Mike Huckabee made some incorrect and questionable claims about Americans who don’t have health insurance, hypothesizing that a third don’t have coverage because “the think they’re healthy and invincible” – a claim for which we find no support – and that another third are self-insured – which is the definition of all people who don’t have health insurance and must pay their own bills. He also understated the number who can’t afford insurance.
• Mitt Romney said the Massachusetts universal health care plan he signed into law as governor didn’t include an “employer mandate,” but the plan includes a number of employer “requirements” with penalties for noncompliance. He also claimed subsidies for low-income individuals were completely financed by a state fund for care of the uninsured. It’s not clear if that will be the case just yet.
• New York Mayor Rudy Giuliani falsely stated that the performance of K-12 students, including Hispanics, in the country has declined. Actually, it has improved.

Rep. Tom Tancredo of Colorado, who has built his campaign on stopping illegal immigration, boycotted the Dec. 9 debate at the University of Miami in Coral Gables, Fla., because it was being broadcast in Spanish. The rest of the pack, whom Tancredo accused of “pandering” to Spanish-speaking voters, attended: Rudy Giuliani, Mike Huckabee, Duncan Hunter, John McCain, Ron Paul, Mitt Romney and Fred Thompson.

Former Arkansas Gov. Huckabee hypothesized about the motivations of the 47 million people in the nation without health insurance, making some wild leaps in the process:

Huckabee: Of those 47 million, one-third don’t have it because they are self-insured. Another one-third don’t have it because they think they’re healthy and invincible. There is one-third that don’t have it because they can’t afford it.

We asked Huckabee’s campaign how he knew that a third of uninsured people “think they’re healthy and invincible,” but we’ve received no response. We can find no studies or reports that support his statement about the self-perceived invincibility of the uninsured. It’s a bit easier to measure how many people turn down available insurance, without speculating on motives: The National Academies report that “only 4 percent of all workers ages 18 to 44 (roughly 3 million people) are uninsured because they decline available workplace health insurance, and many do so because they cannot afford the cost.” The Academies do acknowledge that young adults, age 19 to 34, are more likely to be uninsured than other groups, but offer other reasons besides a sense of invulnerability: They are more likely to be new at their jobs and ineligible for employer-sponsored coverage. Nor do young people make up the bulk of uninsured adults – the majority (61 percent) are over 30.

We also judge that Huckabee errs in claiming that only one-third of individuals who lack insurance do so because they can’t afford it. About two-thirds of the uninsured are considered low-income families (that is, they have an income below 200 percent of the federal poverty level), according to the Kaiser Commission on Medicaid and the Uninsured. Huckabee would be correct to say that a third of the nonelderly uninsured (36 percent) are living below the poverty level, but it would be a stretch to assume that only those with incomes below federal poverty guidelines would be unable to afford insurance. The Kaiser Commission reports that the average annual health-policy premium for a family of four was $12,106 this year. That would consume about 30 percent of total income for a family that’s at 200 percent of the poverty level.

Huckabee’s claim that one-third of the uninsured are self-insured is a meaningless statement. In fact, anyone without health insurance must rely on their own resources to pay medical bills. That’s what being self-insured means.