Wealth, income, and the affordability of health insurance.

There have been debates over how many uninsured people can afford insurance but refuse to purchase it. Examining the difference in asset holdings between the privately insured and the uninsured, we found that the difference in purchasing power is not fully revealed by income comparisons. Median income among the privately insured is 2.9 times that of the uninsured, but median wealth among those with private insurance is 23.2 times that of the uninsured. Our results suggest that assets are an important determinant of effective affordability, undermining the notion that many people are uninsured by choice.