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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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  • Health Insurance Coverage in America: 1999 Data Update

    Report

    Health Insurance Coverage in America: 1999 Data Update This chart book provides the latest information on health insurance coverage, with special attention to the uninsured. It includes trends and major shifts in coverage and a profile of the uninsured population. Chartbook Link to other Health Insurance Coverage in America chartbooks.

  • Directions for Health Reform: Testimony before the Committee on Labor and Human Resources, United States Senate

    Event Date:
    Event

    This testimony presents a brief overview of the uninsured and health insurance coverage in the United States. The testimony describes the important role that the Medicaid program has come to play in providing health insurance coverage for 32 million low-income Americans, and it provides some perspective on policy options for consideration in the debate on the future direction of health reform.

  • A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion

    Issue Brief

    On June 28, 2012, the U.S. Supreme Court issued its decision in the case challenging the Affordable Care Act (ACA). The Court upheld the constitutionality of the ACA's individual mandate, which requires most people to maintain a minimum level of health insurance coverage beginning in 2014. A majority of the Court also found the ACA's Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied…

  • Summary of Coverage Provisions in the Patient Protection and Affordable Care Act

    Issue Brief

    This short summary describes the health coverage provisions contained in the final version of the Affordable Care Act signed into law in March 2010, including the individual mandate requirements, expansion of public programs, health insurance exchanges, changes to private insurance and employer requirements.

  • Changes in Health Insurance Coverage in the Great Recession, 2007-2010

    Issue Brief

    This issue brief examines changes in health insurance coverage over the last decade, with a focus on how changes in the economy, particularly during the "Great Recession" of 2007 to 2009, have affected coverage and the number of uninsured. The paper finds that the number of uninsured grew substantially during the first recession of the decade, increasing by 5 million people from 2000 to 2004; increased more slowly during the brief recovery, growing by 2.1…

  • Key Issues to Consider for Outreach and Enrollment Efforts under Health Reform

    Issue Brief

    The Affordable Care Act will significantly expand health coverage opportunities through an expansion in Medicaid and the creation of new health insurance exchanges in 2014. Effective outreach and enrollment efforts will be vital for assuring the expansions translate into increased coverage. Based on a discussion with federal and state officials and experts, this report identifies key issues to consider with regard to outreach and enrollment under reform. The discussion was part of an ongoing series…

  • The Role of National Firms in Medicare+Choice

    Report

    This report addresses national managed care firms participation in M+C and the factors influencing their decision processes about M+C products. Based on interviews with executives and senior staff of national managed care firms, this report examines how eight national firms strategically position their M+C product, including the process that firms use when making decisions and the key factors they say most influence their decisions related to participation. Report

  • The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis

    Report

    A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population. This analysis uses the Urban Institute’s Health Insurance Policy…

  • Immigrants’ Health Care Coverage and Access (Update)

    Fact Sheet

    Immigrants' Health Care Coverage and Access This fact sheet profiles the health coverage of the nation's immigrant population and the policy challenges the population faces in accessing health care services. Fact Sheet (.pdf)

  • Challenges and Tradeoffs in Low-Income Family Budgets:  Implications for Health Coverage

    Report

    Challenges and Tradeoffs in Low-Income Family Budgets: Implications for Health Coverage - Report This report explores the experiences of families trying to make ends meet on limited budgets. By discussing these families’ work, spending patterns, financial challenges, priorities and tradeoffs and health care and coverage, this report intends to provide a deeper understanding of families’ financial pressures and choices and information to assess the impact of current and proposed policies. Report (.pdf)