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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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  • CHIP TIPS: Citizenship Documentation Changes

    Issue Brief

    This brief, the third in a series, examines changes to citizenship documentation requirements under the Children's Health Insurance Program Reauthorization Act of 2009. The law extends the requirement to document citizenship that applied in Medicaid to CHIP as well. At the same time, it modifies current requirements to reduce the paperwork burden on families and states and helps ensure that eligible children and others are enrolled and receive needed health care without delay. Brief (.pdf)

  • Medicaid’s Role for the Disabled Population Under Age 65

    Fact Sheet

    Medicaid's Role for the Disabled Population Under Age 65 Defines the non-elderly disabled and summarizes Medicaid's role in their health care coverage. Includes a description of enrollment requirements, benefits, spending and managed care concerns for the population. Fact Sheet

  • Low-Income Parents’ Access to Medicaid Five Years After Welfare Reform

    Issue Brief

    This policy brief examines health coverage for low-income parents after the 1996 welfare law broke the historical connection between Medicaid coverage and welfare. Many states have altered their rules and some have expanded coverage for low-income working parents. Policy Brief

  • Disability, Health Coverage, and Welfare Reform

    Report

    This report analyzes data from a survey of 42 low-income families with children with moderate or severe disabilities to better understand the impact of welfare reform on health coverage for these families. Report

  • HIPAA Compliance Strategies In California:  Reforming the State’s Individual Health Insurance Market — Policy Brief

    Other Post

    HIPAA Compliance Strategies In California: Reforming the State's Individual Health Insurance Market -- Policy Brief A policy brief on reform of the individual insurance market and implementation of the Health Insurance Portability and Accountability Act (HIPAA) in California. The brief is based, in part, on discussion at a California Health Policy Roundtable held in Sacramento, California on March 12, 1998. Note: This publication is no longer in circulation. However, a copy may still exist in…

  • Risk Selection Issues Under Medicare Reform Proposals

    Report

    This report compares the provisions designed to guard against risk selection among the Medicare population in both the Congressional Balanced Budget Act of 1995 and in the President's budget plan released in December 1995. The report also explores provisions in both that may exacerbate the potential for risk selection. Report:

  • Medicaid and State Budgets: An October 2001 Update

    Report

    An update to "Medicaid Budgets Under Stress: Survey Findings for State Fiscal Year 2000, 2001, and 2002." This paper was commissioned to evaluate how several states' fiscal outlooks have changed since September 11. ISSUE BRIEF Download FULL REPORT Download

  • Legislative Summary: State Children’s Health Insurance Program – Fact Sheet

    Fact Sheet

    State Children's Health Insurance Program Summary November 1997 Nearly 10 million children are uninsured, often resulting in difficulties in obtaining needed health care. To expand coverage to low-income uninsured children, Congress enacted the State Children's Health Insurance Program (CHIP) as part of the Balanced Budget Act (BBA) of 1997 (P.L. 105-33). This new program allocates $20.3 billion in federal matching funds over five years to states to expand insurance for children. States can use the…

  • 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…