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Quote from KFF President and CEO Drew Altman reads, "when it comes to the “affordability crisis” driving the national discussion of health care today, the chronically ill, and most of all the chronically ill uninsured, are the tip of the spear."

The Group that Struggles the Most in American Health Care

In a new column, Dr. Drew Altman, KFF’s Founding President and CEO, previews findings about the chronically ill uninsured from a large KFF survey of 25,000 Americans focusing on the cost and access challenges facing the chronically ill, which will be released tomorrow. He writes: “There are more than enough needs to go around in American health care, but if I had to pick the one group that struggles the most with costs and access, it would be people with chronic illnesses who are also uninsured.”

Other “Beyond the Data” columns >>

Key Facts about the Uninsured Population

The number and share of people without insurance grew in 2024, increasing for the first time since 2019, according to KFF’s analysis of data from the American Community Survey (ACS). This issue brief describes trends in health coverage in 2024, examines the characteristics of the uninsured population , and summarizes the access and financial implications of not having coverage.

Data and analysis

The coverage gap exists because some states did not expand Medicaid under the ACA to cover adults under age 65 without dependent children with incomes at/below 138% of the federal poverty level (FPL)

How Many Uninsured Are in the Coverage Gap?

An estimated 1.4 million uninsured individuals in the 10 states without Medicaid expansion, including many working adults, people of color, and those with disabilities, remain in the "coverage gap," ineligible for Medicaid or for ACA tax credits that would make coverage affordable.

The Uninsured and Health Coverage

This Health Policy 101 chapter examines the share of the United States population who are uninsured, highlighting their demographics and the challenges they face because of the lack of coverage.

Key Facts on Health Coverage of Immigrants

This fact sheet provides an overview of health coverage for immigrants based on data from the 2023 KFF/LA Times Survey of Immigrants. As of 2023, half of likely undocumented immigrant adults and one in five lawfully present immigrant adults reported being uninsured.

Who was uninsured in 2024?

Latest Polling
9.8%

The share of people under age 65 without insurance
62%

The share of uninsured adults who said they were uninsured because coverage is not affordable
59%

The share of uninsured adults who said they or someone living with them had problems paying for health care
39%

The share of uninsured adults who reported delaying or not getting needed care or medication due to cost
Other key facts about the uninsured >>

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  • Summary Of Early Observations Of The Transition Of Immigrant Families From A Medicaid Look-Alike Program To Basic Health In Washington State

    Issue Brief

    In 2002, the state of Washington eliminated state-funded Medicaid look-alike coverage for certain immigrant families. These families then became eligible for more limited coverage in the state's Basic Health program. This report details the process of this transition and the outcomes for coverage and access for these individuals. Research Brief (.pdf)

  • Managed Care For Low-Income Populations with Special Needs: The Tennessee Experience

    Report

    This paper provides a targeted review of Tennessee's experience providing health care to individuals with special needs under TennCare, its Medicaid managed care initiative. The first part reviews the experience of TennCare Partners, the behavioral health carve-out program created in 1996. The second part reviews how TennCare's structure affects the disabled and chronically ill.

  • How Private Insurance Works: A Primer

    Report

    This primer, prepared by Gary Claxton of the Institute for Health Care Research and Policy at Georgetown University, examines the structure and operation of private health insurance including the types of organizations that provide it, how managed care is delivered, and how risk pools work and describes how private health insurance coverage is regulated under state and federal laws. The primer explains how the current nature of private insurance relates to key issues facing federal…

  • Benefits and Costs of Consumer Protection Proposals in California: An Analysis of Selected Recommendations of the California Managed Care Task Force

    Report

    This report assesses the potential impact of selected recommendations of the Managed Health Care Improvement Task Force in the areas of access to care and specialists, information disclosure, and dispute resolution. The Managed Health Care Improvement Task Force was established in 1998 to inform state leaders about the health industry in California; the impact of managed care on quality, access, and cost of care; issues of special concern to consumers; and the appropriate role of…

  • Protection For Consumers In Managed Care Plans: A Comparison Of Medicare, Medicaid and the Private Insurance Market

    Report

    This policy paper describes key requirements of consumer protection regulation under Medicare, Medicaid and federal and state laws as they apply to private health insurance. These include choice and availability of plans, disclosure of information, marketing, access, quality, and the grievance and appeals process. The discussion highlights differences and similarities across public programs and private insurance and compares public and private insurance protection with provisions of the Consumer Bill of Rights (CBRR) developed by the…

  • Urban Indian Health

    Report

    More than half (57%) of the 2.5 million people who identify themselves solely as American Indian and Alaska Native in the 2000 Census live in metropolitan areas. This issue brief describes the large and growing urban Indian population, their health status, and the major federal health programs and federal-state programs that are available to improve Native Americans' access to needed health services. Report Introductory Letter  

  • Filling an Urgent Need: Improving Children’s Access to Dental Care in Medicaid and SCHIP

    Report

    In October 2007, the Foundation’s Kaiser Commission on Medicaid and the Uninsured and the National Academy for State Health Policy convened a day-long meeting of policy officials and oral health experts to discuss children’s access to dental care in Medicaid and the State Children’s Health Insurance Program (SCHIP) and exchange information and perspectives on the strategies have worked best to improve it. This report summarizes the 15 experts recommendations on a wide assortment of effective…

  • Medicare: Holes in the Safety Net

    Other Post

    Medicare: Holes in the Safety Net This report discusses findings from focus groups that consisted of those individuals who interact with the Medicare program, including beneficiaries, health professionals, caretakers, and program management staff. A press release summarizing the findings of 15 focus groups conducted nationwide on public attitudes toward and understanding of the Medicare system in the United States is available. Note: This publication is no longer in circulation. However, a few copies may still…