"During a recent appearance on The Daily Show, guest host John Oliver and Sen. Rand Paul, R-Ky., engaged in a lively exchange on health insurance. One of the issues they discussed was the high cost of health insurance. Paul, an eye surgeon, is strongly opposed to President Barack Obama’s health care law. During the interview, Oliver pressed him on how to get more Americans signed up for insurance. Paul told Oliver that according to the most recent statistics,  ""85 percent of people had insurance, so 15 percent didn't. So what you need to do is look at who are the 15 percent, and why don't they have insurance? Of the 15 percent who didn't have insurance, half of them made more than $50,000 a year. Why didn't they buy insurance? Because of the expense. They were young healthy people."" In this fact-check, we’ll check whether the cost of insurance is the biggest barrier to uninsured Americans. In a separate report, we’ll look at his claim that half of the uninsured made more than $50,000 a year. Survey data consistently shows that cost is the biggest barrier to uninsured Americans obtaining coverage. When the Kaiser Family Foundation’s June 2013 health tracking poll asked uninsured respondents for the main reason they didn’t have health insurance, a plurality of 40 percent cited cost. The second-biggest factor, at 26 percent, was related to employment, such as being unemployed or having a job that doesn’t offer health insurance. These two reasons aren’t mutually exclusive -- someone could have told the pollster that their lack of a job was the biggest reason but also find cost to be a barrier to obtaining insurance. The only answer in the poll that suggests the respondent doesn’t face a cost obstacle is ""doesn’t need insurance,"" which was the answer of only 11 percent. In another survey, the 2011 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention, researchers asked, ""Which of these are reasons you stopped being covered or don’t have health insurance?’’ Respondents were allowed to choose more than one reason. In this survey, too, a plurality -- 42 percent -- cited cost. Three other reasons cited are compatible with cost being an obstacle -- a lost job or a change in employment (26 percent), an employer that didn’t offer insurance (11 percent) and ineligible due to age or leaving school (9 percent). Just 6 percent cited ""other,"" which included ""didn’t want or need coverage,"" among other answers. ""The cost of insurance is a major reason why people are uninsured -- Sen. Paul is right about that,"" said Jonathan Oberlander, a health policy professor at the University of North Carolina School of Medicine. ""People without access to employer-sponsored coverage have a hard time affording it on their own, and that accounts for most of the uninsured."" Our ruling Paul asked, ""Why didn't (uninsured Americans) buy insurance? Because of the expense."" Survey data supports him. A plurality of respondents in major surveys of the uninsured specifically cite cost as a barrier, and relatively few indicate that going uninsured is a voluntary choice."
Why didn't (uninsured Americans) buy insurance? Because of the expense.