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Uninsured

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.

New and noteworthy

Affordability Is the Issue Now, But Look for the Uninsured to Make a Comeback

A new column on the uninsured from President and CEO Dr. Drew Altman explains: “The uninsured is not the most politically salient problem in health care now, that’s affordability, nor is it the non-problem some say it is. But it’s coming back. And the problem of the chronically ill uninsured is glaring.” Read more.

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.

More on the uninsured population >>

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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  • Incrementalism: Ethical Implications of Policy Choices

    Report

    This paper discusses ethical issues in incremental approaches to expanding health insurance coverage. Although any reduction in the number of uninsured is morally desirable, there are real moral differences between different policy options. This paper, which is part of the Kaiser Incremental Health Reform Project, examines these moral differences by identifying the values and commitments that ground the different policy options. Issue Paper

  • Retiree Health Coverage: Recent Trends and Employer Perspectives on Future Benefits

    Report

    The report, based on an analysis of Hewitt Associates' client database, presents new trend data on the prevalence of retiree health coverage sponsored by large employers and finds a continued erosion of retiree health benefits. The report also includes findings from a new survey assessing how large employers might change their retiree health programs in the future, and on their reaction to the Administration's proposal to add a prescription drug benefit to Medicare. The Hewitt…

  • Racial and Ethnic Disparities in Access to Health Insurance and Health Care

    Fact Sheet

    Racial and ethnic groups in the United States continue to experience major differences in health status compared to the majority white population. Although many factors affect health status, the lack of health insurance and other barriers to obtaining health services markedly diminish minorities' use of both preventive services and medical treatments. This report, produced in collaboration with the UCLA Center for Health Policy Research, examines health insurance coverage and access to physician services among African…

  • The Medicaid Eligibility Maze: Coverage Expands, but Problems Persist

    Report

    This report examines Medicaid eligibility policies and operations in five states - California, Colorado, Florida, Minnesota and Wisconsin - following initial changes introduced by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 and the new Children's Health Insurance Program (CHIP). The study findings suggest that eligibility policy expansions alone may not prevent Medicaid enrollment declines. The report discusses several problem areas affecting Medicaid eligibility and enrollment operations including challenges in severing Medicaid…

  • Getting Behind the Numbers on Access to Care

    Report

    A national telephone survey, conducted by researchers at the Harvard School of Public Health, the Kaiser Family Foundation and the National Opinion Research Center, of 3,993 randomly selected U.S. adults between February and April 1995. The questions probed for three events in the prior year: an episode of being uninsured, problems getting medical care, and/or problems paying medical bills. The 1,234 adults (31% of respondents) who said they had at least one of the three…

  • Federal Policy May Temporarily Close the Coverage Gap, But Long-term Coverage May Fall Back to States

    Policy Watch

    Recent policy attention has focused on closing the coverage gap for roughly 2.2 million individuals living in the 12 states that have not adopted Medicaid expansion included in the Affordable Care Act (ACA). These individuals do not qualify for Medicaid and have incomes below poverty, making them ineligible for premium subsidies in the ACA Marketplace. Pending federal legislation may temporarily provide coverage to individuals in the coverage gap, but providing a permanent pathway to coverage may fall back…

  • Express Lane Eligibility Efforts: Lessons Learned from Early State Cross-Program Enrollment Initiatives

    Issue Brief

    The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provides states new options to reach and enroll eligible but uninsured low-income children into Medicaid and CHIP. The law's Express Lane Eligibility (ELE) provisions enable state Medicaid and CHIP agencies to identify, enroll and recertify children by relying on eligibility findings from other programs, such as Head Start or Food Stamps, rather than having to re-analyze eligibility under their own rules. Further, CHIPRA authorizes greater…

  • Health Affairs Article: Medicaid Expansion Under Health Reform May Increase Service Use and Improve Access For Low-Income Adults With Diabetes

    Issue Brief

    This analysis finds that Medicaid’s role in financing diabetes care will grow when many low-income uninsured people with diabetes become eligible for Medicaid as the program expansions under the Affordable Care Act in 2014. Adult Medicaid beneficiaries with diabetes had annual per person health expenditures more than three times higher than adult beneficiaries without the disease -- $14,229 versus $4,568, according to the study. At the same time, many uninsured adults with diabetes are less…

  • Using Data and Technology to Drive Process Improvement in Medicaid and CHIP: Lessons From South Carolina

    Fact Sheet

    In the past year, there has been a notable trend of states increasingly utilizing data and technology to modernize, streamline, and gain efficiencies in their Medicaid and CHIP programs. The expanded use of data and technology is not only helping states deal with current budget pressures and decreased administrative resources, but also lays important groundwork for the coverage expansions and new coordinated, streamlined, and technology-driven enrollment process that will go into effect in 2014 under…

  • Immigrants’ Access to Health Care

    Issue Brief

    Immigrants account for 20 percent of the uninsured. There are many reasons for immigrants' lack of coverage, but the welfare reform law of 1996 was significant in restricting Medicaid eligibility for certain immigrant populations. The Kaiser Commission on Medicaid and the Uninsured has produced new reports on immigrant health care: a chart pack highlighting statistics and a policy brief discussing the legal status of Medicaid eligibility. An issue paper summarizing the findings of immigrant focus…