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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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  • Toplines: The Public’s Health Care Agenda

    Poll Finding

    These toplines provide the complete survey questions and findings from The Public’s Health Care Agenda for the New Congress and Presidential Campaign, conducted jointly by the Kaiser Family Foundation and the Harvard School of Public Health between November 9 and 19, 2006. The survey looks at the public’s priorities and views on health issues as a new Democratic majority takes the leadership of Congress and as the 2008 presidential campaign begins to take shape. It…

  • Pulling it Together: Separating the Forest from the Trees in the Health Reform Debate

    Perspective

    The good news for those who care about health care is that the issue is rising again on the national agenda. If we have a big debate about health in the presidential campaign and if it is a factor at the polls in 2008, it will help create a mandate for the new president and Congress to make health care a priority in 2009. But the real health care debate has been delayed by the…

  • Five Basic Facts on Immigrants and Their Health Care

    Issue Brief

    As discussions on national health care reform move to the forefront, some have focused on the role of immigrants in the health care system, including their impact on the nation’s uninsured problem, their participation in public health coverage programs, and their use of hospital emergency rooms. To address questions about how immigrants use and affect the health care system, this brief draws on available research and data to highlight five key facts about immigrants’ health…

  • Community Health Centers in an Era of Health Reform: An Overview and Key Challenges to Health Center Growth

    Issue Brief

    Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow. In the Affordable Care…

  • Pulling It Together: Predicting the Future

    Perspective

    A fair amount of attention was given recently to projections made by the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS) about the new health reform law, and how they compare to previous estimates by the Congressional Budget Office (CBO). No doubt the various projections will be grist for claims made in the upcoming political season, so it is important to be clear about the differences between the two estimates and to…

  • Oral Health and Medicare Beneficiaries: Coverage, Out-of-Pocket Spending, and Unmet Need

    Issue Brief

    This brief describes the oral health of Medicare beneficiaries, examines sources of dental coverage for the Medicare population, and examines the utilization of dental services, out-of-pocket spending on dental care, and access problems. This analysis uses data from the National Health and Nutrition Examination Survey (NHANES), the Medicare Current Beneficiary Survey Cost and Use file (MCBS), the National Health Interview Survey (NHIS) and the Kaiser Family Foundation Survey of Health Care Among Nonelderly People with…

  • Pulling it Together: The Sleeper in Health Reform

    Perspective

    The health reform legislation currently being crafted on Capitol Hill is undeniably complex.  To oversimplify slightly it can be boiled down into four parts: coverage (subsidies for private coverage and Medicaid expansions); delivery and payment reforms; insurance market reforms and regulations; and prevention, with each broad category containing a range of specific policy proposals and ideas. There’s been a lot of discussion so far about coverage expansions and how to pay for them, as well…

  • How Accessible is Individual Health Insurance for Consumers in Less-Than Perfect Health?

    Report

    This report documents the findings of a study examining access to health insurance coverage in the individual market for people with health problems. Seven hypothetical consumers with varying health conditions were defined and insurers and HMOs in eight different markets around the country were asked to consider them as though they were real consumers applying for coverage. Renewed debate over proposals to expand coverage for the uninsured using tax credits for the purchase of individual…

  • What Shapes Lawmakers’ Views: A Survey of Members of Congress and Key Staff on Health Care Reform

    Report

    A report summarizing the findings of in-depths interviews conducted with Members of Congress and their staff who were actively involved in the health care reform debate about their opinions about what factors influenced the debate and shaped their views. The report finds that, among media sources, talk radio had the greatest influence in the debate and that public opinion trailed only Administration failures in terms of perceived influence on the debate's outcome. REPORT Download

  • Prescription Drug Discount Cards: Current Programs and Issues

    Report

    As policymakers consider a range of approaches to providing prescription drug coverage to the Medicare population in today s tight budgetary environment, one proposal that has been put forth by the Bush Administration is that of a Medicare-endorsed prescription drug discount card program. This report describes the range of existing discount card programs run by both private sponsors and state governments and provides background information on the implications of this approach to assisting Medicare beneficiaries…