Jennifer Mendoza
Research expert covering health, pharma and medtech
Americans without health insurance – statistics & facts
The United States has a multi-payer health care system, which broadly means that some people are covered by private insurance, while others receive health care from public insurance programs. Unlike other developed countries, the U.S. does not provide universal healthcare coverage to its citizens. Public health insurance programs, especially Medicaid and Children's Health Insurance Program (CHIP) significantly impact the uninsured rates on a state level. Meanwhile, in 2023 around 25 million Americans lacked health insurance coverage. Should uninsured individuals require health care, they are likely to face significant financial consequences and need to pay large medical bills out of pocket. Costs can quickly add up leaving them susceptible to medical debt.
How the Affordable Care Act pushed uninsured rates down
The uninsured rate in the United States stood at 7.6 percent in 2023, but the figure was as high as 16 percent around a decade earlier. In 2010, the introduction of the Affordable Care Act (ACA) helped to address coverage gaps in the health care system. Under the ACA, states now have the option to expand Medicaid to cover nearly all low-income adults under age 65 based on income eligibility thresholds. Previously, most low-income adults without children were not eligible for Medicaid – adults living alone still account for the highest number of non-elderly people without health insurance. States can choose whether or not to expand Medicaid – 10 states have not done so as of May 2024 – and they also have the power to include additional groups and benefits in their version of the plan.The coverage gap
Since 2010, the share of uninsured adults under age 65 has dropped by half in states that have expanded Medicaid, while the share of uninsured adults dropped just one-fifth in non-expansion states. An estimated 1.5 million people fall under the Medicaid Coverage Gap with nearly two-fifth residing in Texas alone. The coverage gap refers to those who earn too much to qualify for Medicaid, but too little to afford private health insurance. In Texas for example, as of May 2024 a parent with dependent children (family of three) earning more than 15 percent of FPL (roughly 320 U.S. dollars) per month would not be eligible for Medicaid. At a time of national and international health crisis, more focus should be given to those without any health coverage.
