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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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  • Preserving Recent Progress for Health Coverage of Children and Parents: New Tensions Emerge

    Report

    The latest survey of eligibility rules and enrollment and renewal procedures in all 50 states and the District of Columbia in their Medicaid and SCHIP programs for children and parents. It reflects changes states implemented between January 2002 and April 2003. The current survey also solicited information about states premiums and cost-sharing practices. Report Enrolling Children and Families in Health Coverage: The Promise of Doing More (50 State Survey as of January 2002) >>All 50-State…

  • Health Care: Squeezing The Middle Class With More Costs and Less Coverage

    Event

    Health Care: Squeezing The Middle Class With More Costs and Less Coverage Diane Rowland, executive vice president of the Foundation and executive director of the Foundation's Commission on Medicaid and the Uninsured, testified to the U.S. House Committee on Ways and Means about the economic challenges of rising health care costs and growing gaps in health coverage facing middle class families. Testimony (.pdf)

  • Health Care in New Orleans: Before and After Katrina

    Event Date:
    Event

    Kaiser Executive Vice President Diane Rowland testified before the House Energy and Commerce Subcommittee on Oversight and Investigations examining the continuing concerns and immediate needs in health care for New Orleans. Testimony (.pdf)

  • Health Coverage in a Period of Rising Unemployment

    Issue Brief

    This policy brief reviews the public and private options available to help people maintain coverage if they become unemployed during a downturn and cannot get employer-sponsored coverage through a spouse. Specifically, it examines COBRA, non-group insurance and Medicaid. And it explains why, despite such options, more people will become uninsured as unemployment rises. Recent analysis predicts that each 1 percentage point increase in unemployment will lead to 1.1 million more uninsured adults. Issue Brief (.pdf)

  • Pulling It Together: A Public Opinion Surprise

    Perspective

    Medicaid is the nation’s primary health insurance program for low-income people and people with disabilities, covering more than 60 million people this year.  And it's about to get a lot of attention: it's likely to be a prime target for spending reductions by "deficit hawks" in debate over the budget; governors are arguing that federal rules requiring them to maintain coverage under Medicaid tie their hands at a time when they are trying to crawl…

  • Pulling It Together: Are We Headed for a Government Takeover of Health Care?

    Perspective

    Remember the “government takeover of the health care system” argument that critics of the health reform law have used?  Well, last week the Office of the Actuary in the Centers for Medicare and Medicaid Services published the latest projections of health spending in the journal Health Affairs.  Attention focused mainly on the Actuary’s estimate that national health spending would grow to almost 20% of GDP by 2020 and that the Affordable Care Act (ACA) would…

  • Pulling it Together: 2012: The ACA, and More

    From Drew Altman

    What is remarkable about 2012 (and the current era in health policy) is how many big health policy issues and marketplace changes will be in play at the same time: HEALTH REFORM: There is the implementation of a historic but fragile health reform law, with a Supreme Court decision pending and so much hanging in the balance. MEDICARE AND MEDICAID: There are continuing debates about potentially big changes in Medicare and Medicaid, driven by the…

  • Impact of Potential Changes to ERISA: Litigation and Appeals Experience of CalPERS, Other Large Public Employers and a Large California Health Plan – Report

    Report

    Impact of Potential Changes to ERISA: Litigation and Appeal Experience of CalPERS, Other Large Public Employers and a Large California Health Plan June 1998 By Coopers & Lybrand L.L.P.Sandra Hunt, M.P.A.John Saari, M.A.A.A.Kelly Traw, J.D. Background The Employee Retirement Income Security Act (ERISA) currently preempts state law related to the wrongful denial or delay of health benefits to the extent that such laws relate to a health benefit plan sponsored by a private employer. This…

  • Medicare: Options for Reform, A Public Dialogue on Health Care: The Future of Medicare

    Report

    A public education brochure describing Medicare reform options that are being considered by Congress. This fact sheet is also a part of a packet of information as part of a joint public information project between Kaiser Family Foundation and League of Women Voters of public meetings held across the United States in October 1998 (#1427, available in print). Report Report

  • Keeping Medicare and Medicaid When You Work, 2005: A Resource Guide for People with Disabilities, Their Families, and Their Advocates

    Report

    This guide helps to explain the program rules for Medicare and Medicaid with regard to work. Medicare and Medicaid have come to play important roles in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and this guide gives people with disabilities new information to help them get the most from these programs. Full PDF Report Section 1: Protecting Health Coverage For People With Disabilities Who Work HTML…