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The Problem of the Uninsured


  • Isaac Ehrlich
  • Yong Yin


The problem of the uninsured cannot be fully understood without considering the role of non-market alternatives to 'market insurance' called 'self-insurance' and 'self-protection' (SISP), including the public 'health care safety-net' system. We tackle the problem by formulating a 'full-insurance' paradigm that accounts for all four interacting insurance measures. We apply two versions of the full-insurance model to estimate, via calibrated simulations, the impacts of SISP on the fraction of uninsured, health spending, and health levels, and to assess how the mandated Affordable Care Act might affect these outcomes in comparison with the CBO projections in 2010. The results indicate that policy analyses which overlook the role of the real price of market insurance relative to the shadow prices of SISP in determining the decision to insure can grossly distort the capacity of mandated reforms like the ACA to insure the uninsured, contain overall health care costs, and improve health and welfare outcomes.

Suggested Citation

  • Isaac Ehrlich & Yong Yin, 2012. "The Problem of the Uninsured," NBER Working Papers 18444, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:18444
    Note: HE AG

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    References listed on IDEAS

    1. Ehrlich, Isaac & Becker, Gary S, 1972. "Market Insurance, Self-Insurance, and Self-Protection," Journal of Political Economy, University of Chicago Press, vol. 80(4), pages 623-648, July-Aug..
    2. Yang-Ming Chang & Issac Ehrlich, 1985. "Insurance, Protection from Risk, and Risk-bearing," Canadian Journal of Economics, Canadian Economics Association, vol. 18(3), pages 574-586, August.
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    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I28 - Health, Education, and Welfare - - Education - - - Government Policy

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