Uninsured in United States

United States

Health insurance coverage has been shown to promote positive health outcomes, increase appropriate use of health care services and offer financial protection against high medical expenses. Those without insurance will often rely on emergency departments to receive care, which costs more and is less efficient. Compared with insured adults, uninsured adults have worse health outcomes, including: 

• Higher rates of mortality and premature death.
• Higher rates of cancer mortality and greater risk of late-stage cancer diagnosis. 
• Inadequate access to quality care, including preventive services. 
• Higher odds of having medical debt.

The nation’s uninsured rate dropped significantly after the Affordable Care Act was enacted, yet over 26.4 million people were still uninsured in 2023. Nearly two-thirds of uninsured nonelderly adults reported they were uninsured because they could not afford health insurance.

According to America’s Health Rankings analysis, the uninsured rate is higher among: 

• Adults ages 26-34 compared with all other age groups. Adults ages 55-64 have the lowest rate. 
• Adults who identify their race as other, American Indian/Alaska Native adults and Hispanic adults compared with other racial and ethnic groups. White and Asian adults have the lowest rates.
• Adults with less than a high school education compared with those with higher levels of education.

Additional research has shown that the uninsured rate is higher among:

• Individuals living in non-Medicaid expansion states compared with those in Medicaid expansion states.
• Individuals with lower income levels compared with individuals with higher incomes. 
• Noncitizens (lawfully present and undocumented immigrants) compared with the general U.S. population.

Medicaid expansion has decreased uninsured rates among low-income individuals and specific populations in states that have enacted it. In 2019, 45% of the uninsured population did not have access to health coverage provided by the Affordable Care Act because they lived in a state that had not expanded Medicaid, they were not U.S. citizens or their income was too high to be eligible.

A Healthy People 2030 leading health indicator is to increase the proportion of people with health insurance.

Buettgens, Matthew, and Urmi Ramchandani. “The Health Coverage of Noncitizens in the United States, 2024.” Brief. Washington, D.C.: Urban Institute, May 2023. https://www.urban.org/sites/default/files/2023-05/The%20Health%20Coverage%20of%20Noncitizens%20in%20the%20United%20States%202024.pdf.

Freeman, Joseph D., Srikanth Kadiyala, Janice F. Bell, and Diane P. Martin. “The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies.” Medical Care 46, no. 10 (2008). https://doi.org/10.1097/MLR.0b013e318185c913.

Garfield, Rachel, and Kendal Orgera. “The Uninsured and the ACA: A Primer — Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act.” KFF, January 2019. https://www.kff.org/report-section/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act-how-does-lack-of-insurance-affect-access-to-care/.

Guth, Madeline, Rachel Garfield, and Robin Rudowitz Published. “The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020,” March 17, 2020. https://www.kff.org/medicaid/report/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review/.

Himmelstein, David U., Samuel L. Dickman, Danny McCormick, David H. Bor, Adam Gaffney, and Steffie Woolhandler. “Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US.” JAMA Network Open 5, no. 9 (September 16, 2022): e2231898. https://doi.org/10.1001/jamanetworkopen.2022.31898.

Keisler-Starkey, Katherine, and Lisa N Bunch. “Health Insurance Coverage in the United States: 2023.” Current Population Reports P60-284. Washington, DC: U.S. Census Bureau, September 2024. https://www2.census.gov/library/publications/2024/demo/p60-284.pdf.

Tolbert, Jennifer, Kendal Orgera, Natalie Singer, and Anthony Damico. “Key Facts about the Uninsured Population.” Issue Brief. KFF, December 19, 2022. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.

Wilper, Andrew P., Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein. “Health Insurance and Mortality in US Adults.” American Journal of Public Health 99, no. 12 (December 1, 2009): 2289–95. https://doi.org/10.2105/AJPH.2008.157685.

Woolhandler, Steffie, and David U. Himmelstein. “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Annals of Internal Medicine 167, no. 6 (June 27, 2017): 424–31. https://doi.org/10.7326/M17-1403.

Zhao, Jingxuan, Xuesong Han, Leticia Nogueira, Stacey A. Fedewa, Ahmedin Jemal, Michael T. Halpern, and K. Robin Yabroff. “Health Insurance Status and Cancer Stage at Diagnosis and Survival in the United States.” CA: A Cancer Journal for Clinicians 72, no. 6 (November 2022): 542–60. https://doi.org/10.3322/caac.21732.