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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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  • Tax Subsidies for Health Insurance: Evaluating the Costs and Benefits

    Other Post

    This technical report provides 1) a description of the detailed simulation model and the assumptions used to analyze the effects of different tax subsidies for the purchase of health insurance coverage, and 2) the results of this analysis. The analysis includes the number of people who gain coverage, overall costs to the government, how much is spent on the currently insured vs. uninsured, and the effects on low-income groups. The results of this report were…

  • Recent Tax Proposals to Increase Health Insurance Coverage

    Other Post

    This report includes a side-by-side analysis of recent tax proposals by Members of Congress and various health organizations designed to increase the number of individuals with private health insurance coverage. Recent Tax Proposals To Increase Health Insurance Coverage

  • Express Lane Eligibility: How to Enroll Large Groups of Eligible Children in Medicaid and CHIP

    Report

    This issue paper explores the potential for increasing enrollment in children's health insurance programs through "Express Lane Eligibility." Express Lane Eligibility is the accelerated enrollment of low-income uninsured children already participating in other income-comparable publicly funded programs, such as WIC or school lunch, into Medicaid or CHIP. The paper reviews Express Lane Eligibility's potential impact on Medicaid and CHIP enrollment, analyzes different models, discusses key challenges with implementation, and suggests steps states and localities can…

  • Variations in State Medicaid Buy-in Practices for Low-Income Medicare Beneficiaries: A 1999 Update

    Report

    This report updates a 1997 Foundation report to assess how states are implementing financial protections for the 16 million Medicare beneficiaries who are low-income. These protections, generally referred to as "buy-in programs," help low-income Medicare beneficiaries meet Medicare's cost-sharing requirements by using state Medicaid programs to pay either all or some portion of premiums, deductibles, and coinsurance amounts. Using information collected through a survey of state Medicaid directors and consumer advocates, the update seeks to…

  • Long-Term Care:  Medicaid’s Role and Challenges

    Issue Brief

    Long-Term Care: Medicaid's Role and Challenges This Policy Brief examines Medicaid's role in providing long-term care services. It describes long-term care services, the population that needs these services, and how people get long-term care services. It provides an overview of health insurance coverage of persons with long-term care needs and describes both Medicare's and Medicaid's role in providing these services. It also examines some of the policy issues and challenges involved in providing long-term care…

  • The Kaiser Project on Incremental Health Reform

    Other Post

    In November 1996, the Kaiser Family Foundation initiated a project to examine different strategies for expanding health insurance coverage to America's growing uninsured population. The Foundation asked two leading health policy experts with experience in Democratic and Republican leadership roles, Judith Feder and Sheila Burke, to direct the project's work in considering and evaluating the potential for, and likely impact of, alternative incremental reform options. This continuing effort has made important contributions to the public…

  • Medicaid and Welfare Reform: States’ Use of the $500 Million Federal Fund

    Report

    This report reviews how states have responded to the $500 million federal fund that was created by the federal welfare reform legislation in 1996 to help states maintain Medicaid coverage for individuals affected by welfare reform. State Medicaid officials were asked whether they have drawn down federal funds from the $500 million fund; to describe the factors that influenced their decision; and what activities they are supporting with the additional federal monies. The paper describes…

  • The Difference Different Approaches Make: Comparing Proposals to Expand Health Insurance

    Report

    The Difference Different Approaches Make: Comparing Proposals to Expand Health Insurance This paper estimates and compares the impacts of alternative mechanisms for expanding health insurance coverage. A variety of approaches-expansions of existing public programs, direct subsidies, and tax credits-and target populations-including children, poor adults, parents of Medicaid- or CHIP-covered children, and early retirees-are considered. The impacts of the proposals on coverage, costs and other program outcomes are compared. This paper is part of the Kaiser…

  • Insurance Market Reforms and the Individual Insurance Marketplace: Implications for Coverage Expansions

    Report

    Proposals that attempt to expand coverage in the private individual insurance market will only work if private insurance is available and affordable. This paper describes how the current individual marketplace will affect the ability of such proposals to assure equitable access to affordable coverage. This paper is part of the Kaiser Incremental Health Reform Project. Issue Paper