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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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  • How Does Health Coverage and Access to Care for Immigrants Vary by Length of Time in the U.S.?

    Issue Brief

    This analysis, based on data from the 2007 Health Tracking Household Survey, examines how health coverage and access to care for non-elderly adults vary based on immigrants’ length of time in the U.S. and between immigrants, second generation Americans and third generation and higher Americans. It also identifies the primary factors contributing to lower health coverage rates and greater access barriers among immigrants. While, overall, immigrants have a high uninsured rate and face greater access…

  • Side-by-Side Comparison of Major Health Care Reform Proposals

    Issue Brief

    On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, and a week later, signed into law the Health Care and Education Reconciliation Act of 2010, which made some changes to the comprehensive health reform law. Summary of Final Health Care Reform Law (.pdf) Download a printable comparison of the new health reform law (the Patient Protection and Affordable Care Act), the House-passed Health Care and Education Reconciliation Act…

  • Pulling it Together: The Experts vs. The Public on Health Reform

    Perspective

    In repeated Kaiser polls, we see a divide between what experts believe and what the public believes about some of the key issues in health reform. They don’t disagree on everything; far from it. But there is a wide gulf on basic beliefs about what is behind the problems in the health care system and key elements of reform, especially delivery reform. Experts believe the health care system is full of unnecessary care and troubling…

  • 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…

  • Explaining Health Care Reform: What Is An Employer “Pay-or-Play” Requirement?

    Issue Brief

    To broaden coverage, some health reform proposals would require employers to offer coverage or pay to help finance subsidies for those without access to affordable coverage. These types of reforms are often referred to as “pay-or-play” policies. The brief explains the concept and policy implications of employer pay-or-play proposals, which can vary in terms of the level of coverage required for compliance, the cost of the penalty to employers who do not offer, and whether…

  • Explaining Health Care Reform: What is Health Insurance?

    Issue Brief

    A key element in any comprehensive health reform plan is defining what health insurance is and the amount of insurance coverage people will have. There are two components to that coverage: the types of services covered (e.g., physician care, hospitalization, prescription drugs, etc.), and the cost sharing required of enrollees (e.g., the annual deductible, the copayments or coinsurance, and the maximum out-of-pocket costs for a year). The overall approach to reform drives the kinds of…

  • Pulling it Together: About Kaiser Health News

    Perspective

    There is lots of apocalyptic talk these days about the collapse of the newspaper industry and the challenges facing news organizations.  There is even talk of the unimaginable, my hometown paper The Boston Globe shutting down. Surely they know that Red Sox Nation cannot exist without the Globe Sports pages. All kinds of solutions have been proposed, from micro-payments for news stories like songs on iTunes to foundation-endowed daily newspapers.  There is growing talk of…

  • Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility

    Issue Brief

    Low-income adults (those with incomes below 200 percent of poverty, or $33,200 for a family of three in 2007) account for just over half of the non-elderly uninsured in the United States. This brief reviews the health coverage of non-elderly low-income adults and discusses the implications for national health reform efforts of broadening coverage for this population by filling gaps in Medicaid eligibility. Low-income adults are more than twice as likely to be uninsured as…

  • The Coverage and Cost Impacts of Expanding Medicaid

    Report

    This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates. The analysis models two primary options to expand Medicaid (250% FPL for children, 100% FPL for adults; 300% FPL for children, 150% for adults) as well as the same options with no change for children. Report (.pdf)

  • Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations

    Issue Brief

    Medicaid is the health insurance safety net for nearly 60 million of the nation's poorest and sickest individuals. It provides access to a comprehensive scope of benefits with limited cost-sharing that is geared to meet the health needs and limited resources of the low-income, high-need populations it serves, populations for whom private coverage is often not available, not affordable or inadequate. This paper, based on years of research and analysis from the Kaiser Commission on…