Heritage Foundation Leadership for America

Treat health plans like car insurance and people will cover themselves.

The good news is that we know a lot about who the uninsured are -- and why they're uninsured.

They usually cannot, or do not, get health insurance through their place of work. They are overwhelmingly low-income working people. They tend to be young, are disproportionately minority and are often concentrated in small businesses, particularly in retail trade and service industries.

When they buy health insurance on their own, they get no federal and state tax breaks for the purchase, unlike workers who get coverage through their employers. This makes these workers' health coverage far more expensive for them to buy. No wonder they don't, or can't, purchase insurance.

The "hard core" uninsured -- those persistently uninsured over a long period of time -- are, in fact, a relatively small part of the problem. Based on the best evidence in the professional literature, the vast majority of the uninsured are people who are in and out of coverage, people who experience gaps or frequent changes in coverage.

Normally, people own their own auto, life and homeowners insurance policies. So when they change jobs or lose jobs, they don't lose these insurance policies. But with health insurance, the employer owns the policy; and because the employer owns it, the employee can't take it from job to job. The best a departing employee can do, under current law, is pay the full premium for an often-unaffordable employer plan for a limited period of time.

So the problem of the uninsured isn't simply getting access to health insurance coverage, but keeping it once they have it.

The right policy, then, is to tie health insurance to the person, not the job. That one, simple change would make a dramatic difference in reducing the numbers of the uninsured.

What is to be done? First, create a new kind of health-insurance market and allow individuals and families to pick and choose the plan of their choice. Allow them to own it just as they own every other type of policy, and permit them to take it with them from job to job without losing any of the generous federal and state tax breaks for health insurance.

Gov. Mitt Romney of Massachusetts has created just such a new, consumer-driven market for workers and their families in the small-business sector, guaranteeing them portability of affordable health-care coverage.

Second, target assistance to uninsured individuals in the form of health-care tax credits, enabling them to get the health insurance they want without a tax penalty. For low-income people who don't pay taxes, provide a voucher or "premium assistance," so that they can afford coverage.

The problem of the uninsured is tough, but it is not insoluble. It takes only political will, which is routinely in short supply.

Robert E. Moffit, Ph.D., is Director of the Center for Health Policy Studies at The Heritage Foundation.