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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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  • Five Key Questions And Answers About Section 1115 Medicaid Waivers

    Issue Brief

    This issue brief provides an overview of what Section 1115 Medicaid waivers are, how they are approved and financed, how states have used them, and how they are impacted by health reform. For many years, Section 1115 waivers have been used by states to test new coverage approaches not otherwise allowed under Medicaid program rules. Some waivers have also raised important policy issues. Since the passage of the health reform law, several states, including California,…

  • Options for Expanding Health Insurance Coverage: Report on a Policy Roundtable

    Report

    This paper is a summary of a 1999 policy conference, The Kaiser Incremental Health Reform Project, which highlighted both the policy and politics of incrementalism. This paper identifies issues and tradeoffs associated with alternative approaches to expanding health insurance coverage-including enactment and implementation of CHIP and further coverage expansions through public programs and tax credits for the purchase of private health insurance. ISSUE BRIEF Download

  • Coverage of Gynecological Care and Contraception

    Fact Sheet

    Gynecological services are vital for women throughout their lifetimes. Pap smears, breast exams, counseling, and contraceptive care are important preventive services, but women often do not get these at levels recommended by experts. This fact sheet summarizes coverage of gynecological care and contraceptives. It focuses on women's use of services, types of providers, and types of insurance. Special emphasis is given to uninsured women and those with Medicaid coverage. Fact Sheet:

  • 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

  • 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…

  • Medicaid and Managed Care: Implications for Low-income Women

    Report

    This commentary reviews Medicaid's role for low-income women and examines the implications Medicaid managed care on the delivery of health services to this vulnerable population. Today 40% of the Medicaid population, mostly poor women and their children, is enrolled in managed care. Medicaid agencies are hoping managed care will control spending and address longstanding problems with access to care. Low-income women have a number of characteristics that make them doubly vulnerable to have trouble accessing…

  • Implementation of Managed Care Consumer Protections in Missouri, New Jersey, Texas & Vermont

    Report

    This study goes beyond the legislative debates over expanded patients' rights to explore how managed care consumer protections have actually been implemented in four states (Missouri, New Jersey, Texas & Vermont) all of which have been active in this area. The study describes the details of the reforms, the issues that have arisen in implementation, and the lessons for policymakers from the experiences of these states. An Overview/Executive summary of the full report is also…

  • Health Coverage for Latino Children:  Medicaid and the Children’s Health Insurance Program

    Other Post

    Health Coverage for Latino Children: Medicaid and the Children's Health Insurance Program An overview of Medicaid, the Children's Health Insurance Program (CHIP) and health care coverage for Latino Children. This issue brief was released at a briefing for Hispanic and Latino Media in Los Angeles, CA on June 24, 1999. The briefing is part of a series, Latino Voices for Latino Health: Three Cities, One Vision that is jointly coordinated by the Kaiser Family Foundation…

  • 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…

  • Health Centers’ Role as Safety Net Providers for Medicaid Patients and the Uninsured

    Report

    This issue paper profiles the role America's health centers have played in providing care for Medicaid patients and the uninsured. The paper presents information on health center patients and revenue sources and analyzes similarities and differences both between health centers and private practices and among health centers. These centers perform a unique role in the American health care system as nearly 85 percent of their patients are low-income and more than a third of their…