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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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  • Chartpack — The Public’s Health Care Agenda for the New President and Congress

    Poll Finding

    Chartpack -- The Public's Health Care Agenda for the New President and Congress This chartpack provides the key findings from the survey of the public's attitudes regarding the health care agenda for President Obama and the new Congress in 2009. It assesses the relative priority placed on health care by the American public as part of addressing the economic recession and as a large scale reform issue. The public's priorities for health care reform and…

  • CHIP TIPS: Medicaid Performance Bonus “5 of 8” Requirements

    Issue Brief

    This brief, the second in a series, examines the requirements that states must meet to be eligible for the new "performance bonus" available to states that do an especially good job of signing up eligible children for Medicaid. The bonus, created by a provision in the Children's Health Insurance Program Reauthorization Act of 2009, is designed to help states cover the added costs that result when states are very successful in enrolling eligible children in…

  • Pulling It Together: Medicare, Medicaid, and The Multiplier Effect

    Perspective

    We are witnessing a battle in Washington right now about the future of health care’s two big public programs, Medicare and Medicaid. It’s a budget battle, it’s an ideological battle, it’s a partisan political battle, and while it might not always be obvious following the debate, it’s a high stakes battle for people. In 2011, over a hundred million low-income, disabled, and elderly beneficiaries will be served by the two programs. Many of the proposals…

  • Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion

    Report

    Beginning in 2014, the Affordable Care Act ACA provides for a significant Medicaid expansion uninsured, low-income adults. Given their low incomes and high uninsured rate, individuals experiencing homelessness could significantly benefit from this expansion. However, it will be important to address the barriers they face to enrolling in coverage and accessing needed care. This report, based on eight focus group discussions with administrators and frontline workers serving the homeless population in four cities, identifies enrollment…

  • SCHIP Program Enrollment: June 2003 Update

    Report

    This SCHIP enrollment report finds that overall enrollment growth is slowing and enrollment declined in 13 states. It also found that some states are capping enrollment and a handful of sates are reducing eligibility and benefits under SCHIP. Report (.pdf)

  • Update on Individual Health Insurance

    Report

    This report provides information about the individual health insurance market using data from the largest vendor of this type of insurance, eHealthInsurance. The report includes who is buying individual insurance, what they are actually paying for the insurance, and buying patterns. It is the first in an up-coming series of reports jointly produced by the Kaiser Family Foundation and eHealthInsurance to provide trend information in such areas of interest as premiums and cost sharing, and…

  • A Profile of American Indians and Alaska Natives and Their Health Coverage

    Issue Brief

    A Profile of American Indians and Alaska Natives and Their Health Coverage This brief examines the health coverage, access to care and health status of American Indians and Alaska Natives across the country. Although the U.S. government has an established responsibility through tribal agreements to provide health care services to members of federally recognized Indian tribes, many American Indians and Alaska Natives lack access to health care. The brief gives an overview of the some…

  • With Federal Support, States Hold Steady in Medicaid and CHIP Coverage Policies for Low-Income Children and Families Despite Recession

    News Release

    New 50-State Survey Finds Some States Make Targeted Expansions to Strengthen Coverage and Achieve Efficiencies as They Prepare for Health Reform WASHINGTON -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children’s Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs’ ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today…

  • Improving Access to Adult Primary Care in Medicaid: Exploring the Potential Role of Nurse Practitioners and Physician Assistants

    Issue Brief

    The inadequate supply of primary care providers is among the major challenges facing the U.S. health care system. Sixty-five million people live in areas designated by the federal government as having a shortage of primary care providers. Under the Patient Protection and Affordable Care Act (ACA), the pressures on access are certain to grow as millions of newly insured people enter the health care system. By 2020, the U.S. will face an estimated shortage of…

  • Massachusetts Health Care Reform: Six Years Later

    Issue Brief

    In 2006, then-Gov. Mitt Romney signed Massachusetts' comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts' experience with coverage and access to care over the last six years, as well as the state's ongoing efforts to deal with persistent high health-care costs. The…