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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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  • New Reports Examine Near-Elderly Health Coverage Trends and Six Near-Elderly Uninsured Individuals’ Experiences with the American Health Care System

    Report

    Two new reports focus on health coverage in the near elderly (age 55-64) population. One report examines trends in the population's income, health status, and insurance coverage and the other report profiles six near-elderly uninsured individuals' life challenges in the years preceding Medicare eligibility. Health Insurance Coverage of the Near Elderly At the Edge: Near Elderly Americans Talk About Health Insurance

  • Stresses to the Safety Net:  The Public Hospital Perspective

    Report

    The nation’s safety net financing is fragmented; consequently, providers must knit together resources from many different funding sources to create a stream of revenue to cover the costs of providing a very broad range of services. This report describes those sources of revenue, documenting that nearly 40% of all safety net revenues are from Medicaid. The report also describes challenges that safety net hospitals and health systems are experiencing as they attempt to rebound from…

  • Medical Debt and Access to Health Care

    Report

    This study examines the privately insured who have had problems paying medical bills and compares their access to care to those who have not had medical bill problems as well as those with no health coverage at all, using a national representative survey of adults. The study finds that care-seeking patterns among those with private coverage but having problems paying their medical bills resembled those of the uninsured. Executive Summary (.pdf) Report (.pdf)

  • Private Long-Term Care Insurance: A Viable Option for Low and Middle-Income Seniors?

    Issue Brief

    In the Deficit Reduction Act of 2005, the federal government made it harder for individuals to qualify for Medicaid nursing home benefits by increasing penalties on individuals who have transferred assets for less than fair market value during the past five years and by making individuals with home equity above $500,000 ineligible for nursing home benefits. The legislation also lifts the moratorium on the number of states that may operate Long-Term Care (LTC) Partnership Programs,…

  • Study Shows Uninsured Receive Less Care and Experience Worse Outcomes

    Event Date:
    Event

    A new study commissioned by the Kaiser Family Foundation and authored by Dr. Jack Hadley of The Urban Institute and featured in the March 14, 2007, Journal of the American Medical Association theme issue on Access to Care documents that people who are uninsured receive less care and have worse outcomes following an accident or the onset of a new chronic condition than those with insurance. The study -- based on analysis of eight years…

  • Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Adults

    Issue Brief

    This brief analyzes health insurance coverage and access for low-income non-citizen adults and discusses provider insights into the obstacles this population faces in obtaining coverage and receiving care. Overall, non-citizen adults account for just under one-fourth of all non-elderly uninsured adults. Low-income uninsured adults are at particularly high risk for being uninsured due to very limited access to both private and public coverage. The brief finds that, largely due to their high uninsured rate, low-income…

  • Pulling It Together: Critical Path To Health Reform: Stage One

    Perspective

    Will there be a big debate about health reform in the general election? If there is it will elevate the issue further, engage the public, and create momentum and a mandate for action by a new President and Congress. If, however, the debate about health is tepid or health is eclipsed by other issues such as the economy and Iraq, momentum could falter. One measure of the level of debate will be whether or not…

  • Pulling it Together: The Health Care Industry’s Second Voluntary Effort

    Perspective

    The announcement that health care industry groups plan to put on the table voluntarily a package of proposals to shave $2 trillion off the rate of increase in health spending over the next ten years immediately conjures up the image of the Voluntary Effort or VE launched with similar fanfare in the Carter administration.  Back then the industry used the VE to fend off Jimmy Carter's efforts to aggressively control the costs of hospital care…

  • Why Express Lane Eligibility Makes Sense for States and Low-Income Families

    Issue Brief

    Express Lane Eligibility (ELE) is a new tool available to states to streamline enrollment and renewal of children in Medicaid and CHIP. It allows state Medicaid and CHIP agencies to utilize data and eligibility findings from other public need-based programs, such as Head Start or Food Stamps, and/or tax return data to identify, enroll and recertify children rather than requiring them to re-analyze and determine eligibility under their own rules. This issue brief, one in…

  • Pulling it Together: Seniors and Health Reform

    Perspective

    It is widely believed that seniors are antsy about the new health reform law. And there is heightened interest in how seniors feel about the law in the political world because they are more likely to vote in midterm elections.  About 48% of the electorate said they voted in the 2006 midterms while about 63% of seniors said the same.  Our June and July tracking polls shed light on seniors’ views on health reform and…