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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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  • Five Key Questions About Medicaid And Its Role in State/Federal Budgets and Health Reform

    Report

    This fact sheet highlights key issues about Medicaid, including the structure, financing and purpose of the program, its role for low-income beneficiaries, its share of the federal budget and state budgets, and the significant implications of the coverage expansion under the Affordable Care Act. Fact Sheet (.pdf) Related chartpack: Five Key Questions And Answers About Medicaid

  • Explaining Health Reform: Building Enrollment Systems That Meet The Expectations of the Affordable Care Act

    Issue Brief

    The new health reform law will require most U.S. citizens and legal residents to have health coverage by 2014. It provides new options for coverage by expanding Medicaid eligibility to more low-income people and creating a state-based system of health insurance Exchanges through which individuals can purchase coverage, with federal subsidies for many. The success of the law in achieving near-universal health coverage will depend on the effectiveness of the enrollment and renewal processes that…

  • Health Coverage in an Economic Downturn: Impact of Tight Budgets on Families and States

    Fact Sheet

    The economic downturn has strained family finances and prompted some Americans to cut back on medications and forgo preventive care and visits to the doctor. At the same time, the downturn has triggered declines in tax revenue that inhibit states’ ability to meet rising Medicaid program costs as enrollment spikes during economic hard times. Many states are expected to struggle to close budget gaps despite moves by Congress and the Obama Administration to temporarily boost…

  • CHIP Enrollment: June 2011 Data Snapshot

    Issue Brief

    This data snapshot provides the latest data on Children's Health Insurance Program (CHIP) enrollment and policy trends nationally and across the states through June 2011, based on survey responses and data provided by CHIP directors in all 50 states and the District of Columbia. The report finds that in June 2011, the number of children enrolled in CHIP reached 5.3 million. From June 2010 to June 2011, an additional 178,000 children enrolled in CHIP programs…

  • Testimony on the National Governors’ Association Proposal on Medicaid – Report

    Report

    Hearing before the United States House of Representatives Committee on Commerce on the National Governors Association Proposal on Medicaid Testimony of Diane Rowland, Sc.D., Executive Director, Kaiser Commission on the Future of Medicaid and Senior Vice President, Henry J. Kaiser Family Foundation March 6, 1996 Thank you, Mr. Chairman and members of the Committee, for this opportunity to provide some perspective on the recent proposal of the National Governors Association for Medicaid reform and its…

  • Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable

    Issue Brief

    Half of all Medicaid enrollees receive care through comprehensive risk-based managed care organizations (MCOs). Most Medicaid MCO enrollees today are low-income children and parents, but states are increasingly moving beneficiaries with more complex needs into MCOs. Managed care enrollment may grow more rapidly as states work with the Centers for Medicare & Medicare Services (CMS) to implement initiatives to better integrate Medicare and Medicaid benefits and care for dual eligibles. The Foundation’s Kaiser Commission on…

  • Program Integrity in Medicaid: A Primer

    Issue Brief

    Medicaid covers more than 60 million Americans and accounts for about one in six dollars spent on health care in the United States. Multiple agencies at the state and federal levels are involved in efforts to prevent waste, fraud and abuse in the program and ensure appropriate use of taxpayer dollars, and many program integrity initiatives are yielding positive results. The Affordable Care Act (ACA) builds on earlier efforts through the Deficit Reduction Act to…

  • Cost and Access Challenges: A Comparison of Experiences Between Uninsured and Privately Insured Adults Aged 55 to 64 with Seniors on Medicare

    Report

    This analysis looks at the difficulties uninsured people ages 55-64 have accessing and affording health care in 2010. Four in 10 of these near-seniors report having unmet health care needs or delaying treatment, while three in 10 uninsured near-seniors lived in families reporting problems paying their medical bills largely due to the cost. Seniors on Medicare report problems accessing care at a significantly lower rate than uninsured near-seniors and at a similar rate to near-seniors…

  • States Getting a Jump Start on Health Reform’s Medicaid Expansion

    Issue Brief

    One of the primary goals of the Affordable Care Act (ACA) is to decrease the number of uninsured through a Medicaid expansion to nearly all individuals with incomes up to 133 percent of the federal poverty level (FPL) ($14,856 for an individual or $25,390 for a family of three in 2012) and the creation of new health insurance exchanges. These coverage expansions, which will take effect in 2014, will eventually cover about 32 million uninsured…