Senate health-care bill would still leave millions uninsured

There is little support in Congress for extending health insurance through Medicaid or subsidies to the millions of illegal immigrants in the United States.

Congress is seeking to cover people who are under 30 and who find insurance an expense they can live without because they are generally healthy; many in this group hold part-time jobs that do not offer coverage. Lawmakers' goal is twofold: reducing the burden on hospitals to care for the uninsured and broadening the pool of people with insurance, since including those who are healthy helps lower costs for the ill. The legislation would create health plans with low monthly costs designed to appeal to young people.

Some experts say this group -- 13 million Americans, according to some estimates -- will remain sizable despite the mandate. But David Cutler, an economist at Harvard who advised Barack Obama on health care during the presidential campaign, said this group could be almost universally insured if the law was implemented properly, thereby reducing the total number of uninsured to much less than 20 million.

He said that if the bill becomes law, the government should look to Massachusetts, which passed a requirement in 2006 that every resident get insurance. The state ran commercials during the broadcast of Boston Red Sox baseball games encouraging people to sign up, helping reach young men. Only about 45,000 of the nearly 4 million who filed taxes last year in Massachusetts were fined for refusing to buy insurance.

Cutler said a similar effort could encourage people who would newly qualify for Medicaid, which would be expanded to cover most households earning less than $30,000 a year.

"If we do it right," Cutler said, "I'm not very worried we will have lots of uninsured."

Research editor Alice Crites contributed to this report.