John Goodman and colleagues have long pointed out that being “uninsured” is not a meaningful indicator of access to medical care in the U.S.  Uninsured Americans consume more primary care than “universally” insured Canadians. Patients in ERs are treated the same, whether they are uninsured or on Medicaid, and eligible patients can enroll in Medicaid after they’ve become sick. The New York Times’ Nicholas Kristof recycles the claim that being uninsured causes about 1,000 deaths a year amongst hospitalized children. But if you read the original, scholarly article, carefully, you’ll see that the authors include children who received Medicaid “retroactively” as insured (p. 7). 

So, if we are to consider the millions of kids who are eligible but not enrolled in Medicaid or SCHIP as “insured,” everything’s fine. But that’s surely not what Kristof means. When the authors re-categorized those who retroactively signed up for Medicaid as “uninsured” when hospitalized, the adjusted mortality rate for the insured was 0.44% versus 0.52% for the uninsured. It is highly unlikely that this difference is statistically significant, and the authors don’t clarify one way or the other.