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How Many Uninsured Are in the Coverage Gap?

This analysis estimates that 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 tax credits that would make coverage ACA's Marketplaces affordable to them.

Key Facts about the Uninsured Population

The number of people ages 0-64 who were uninsured held steady at 25.3 million in 2023, although the number of uninsured children rose from 3.8 million to 4.0 million. Most uninsured people are in low-income families and have at least one worker in the family.

How the Unwinding Affected Enrollees

Over half who were disenrolled say they put off needed medical care while trying to renew Medicaid. Overall, 19% of adults who had Medicaid prior to the start of unwinding say they were disenrolled at some point in the past year. Of this group, a large majority (70%) were left at least temporarily uninsured.

The uninsured: How costs affect care and health, 2023

Latest Polling
8%

Percent of adults who reported not having health insurance
55%

Percent of uninsured adults who reported delaying or forgoing some form of health care due to cost
19%

Percent of uninsured adults who report that they or a family member had difficulty paying medical bills
38%

Percent of uninsured adults who reported not having a usual source of care (vs. 8% of insured adults)
Peterson-KFF Health System Tracker

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  • Community Health Center Patients, Financing, and Services

    Issue Brief

    This brief reports on community health center patients, services, experiences, and financing in 2023 and analyzes changes from 2019 (pre-pandemic) through 2023 using data from the Uniform Data System (UDS) and the 2022 Health Center Patient Survey.

  • Making Sense of Medicaid Work Requirements

    From Drew Altman

    In this column, KFF President and CEO Drew Altman examines the data and history around adding work requirements to Medicaid and why the administrative burdens it imposes may offset any savings even for states that ideologically favor such an approach.

  • With or Without ACA Repeal, ACA and Medicaid Cuts are Looming

    Perspective

    In this JAMA Health Forum post, Executive Vice President Larry Levitt explores why the incoming Trump administration and Republican majorities in Congress are likely to pursue budget cuts in Medicaid and the Affordable Care Act and why such efforts are likely to boost the number of uninsured Americans.

  • COVID-19 Vaccine Access for Uninsured Adults this Fall

    Policy Watch

    This policy watch provides an overview of how uninsured adults currently access recommended vaccines, how they have accessed COVID-19 vaccines thus far, including what is known about their vaccine uptake, and proposed plans to provide COVID-19 vaccines to uninsured adults this fall and beyond.

  • Do State Decisions to Prioritize Renewals for Medicaid Enrollees Who are Likely Ineligible Affect Early Disenrollment Rates?

    Policy Watch

    Some states are prioritizing Medicaid renewals for enrollees flagged as likely to be ineligible. Early data from Arizona, Idaho, and Pennsylvania show disenrollment rates for flagged enrollees are higher than for other enrollees. This analysis considers why different state approaches to renewals may explain some – but not all – variation in disenrollment rates across the U.S.

  • How Many People Might Lose Medicaid When States Unwind Continuous Enrollment?

    Issue Brief

    Between 8 and 24 million people across the U.S. could be disenrolled from Medicaid during the unwinding of the program’s continuous enrollment provision. KFF's new analysis offers three illustrative scenarios for how state-level Medicaid enrollment could decline between March 2023 and May 2024, ranging from 8 percent to 28 percent of total enrollees. 

  • Section 1115 Waiver Watch: Continuous Eligibility Waivers

    Policy Watch

    The pandemic continuous enrollment provision and other research show that continuous eligibility reduces Medicaid disenrollment and “churn” rates and helps to ensure stable coverage. As many Medicaid enrollees are currently experiencing disruptions in coverage as a result of the Medicaid unwinding, a number of states are pursuing strategies to help promote continuity of coverage, including through unwinding waivers and Section 1115 demonstration waivers. This Waiver Watch summarizes approved and pending Section 1115 waivers with continuous eligibility provisions for children and adults in Medicaid.

  • Where ACA Marketplace Enrollment is Growing the Fastest, and Why

    Policy Watch

    In 2024, Affordable Care Act (ACA) Marketplace enrollment hit a new record high, reaching over 21 million people. This policy watch discusses the the factors contributing to the increased enrollment in the fastest growing marketplaces.