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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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  • Uninsured and Their Access to Health Care, 2005

    Fact Sheet

    The Uninsured and Their Access to Health Care This fact sheet describes the characteristics of the uninsured population, the difference health insurance makes, and why there is a large uninsured population. Fact Sheet (.pdf)

  • Health Coverage in America, 2004 Data Update

    Report

    This chartbook provides 2004 data 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. Report (.pdf)

  • Racial and Ethnic Disparities in Women’s Health Coverage and Access to Care

    Issue Brief

    Using data from the 2001 Kaiser Women’s Health Survey, a nationally representative survey of nearly 4,000 women between the ages of 18 to 64, this issue brief explores racial and ethnic disparities in health care among women. It provides new information on the differences in health status, health insurance coverage, and selected measures of access to care across three racial/ethnic groups of women: African American, Latina, and white. Issue Brief (.pdf)

  • What Happened to the Insurance Coverage of Children and Adults in 2006?

    Issue Brief

    A new, detailed analysis of the latest US Census Bureau data on health insurance coverage looks behind the 2.2 million increase in the number of uninsured, examining changes by age and income. Reversing years of steady declines, the number of uninsured children has grown by one million over the last two years. And, as debate continues on reauthorization of SCHIP, the analysis shows that 48 percent of the increase in uninsured children from 2005 to…

  • Health Coverage for Low-Income Adults:  Eligibility and Enrollment in Medicaid and State Programs, 2002

    Issue Brief

    Health Coverage for Low-Income Adults: Eligibility and Enrollment in Medicaid and State Programs, 2002 This policy brief provides new information on the number and characteristics of nonelderly adults eligible for Medicaid and other public coverage and on their enrollment. Because low-income adults often work at jobs that do not offer employer-sponsored coverage and individual coverage is prohibitively expensive for them, their uninsured rates are high. Although Medicaid and the State Children's Health Insurance Program (SCHIP)…

  • What Is the Current Population Survey Telling Us About the Number of Uninsured?

    Issue Brief

    This brief describes the main concerns with the Census Bureau’s CPS health coverage estimates and how analysts have attempted to adjust for problems, and concludes with implications for how the CPS might be enhanced in order to improve the measurement of health insurance coverage. Issue Paper (.pdf)

  • The Role of Consumer Copayments for Health Care: Lessons From the RAND Health Insurance Experiment and Beyond

    Report

    The appropriate level of cost-sharing for patients remains a key issue in designing both private and public health insurance. This report reviews the groundbreaking RAND Health Insurance Experiment from the 1970s to offer insights into current policy debates about appropriate cost-sharing levels. One of the most ambitious health policy studies in U.S. history, the RAND experiment randomly assigned thousands of families to insurance with varying levels of patient co-insurance. The researchers followed the participants for…

  • Health Coverage For Low-Income Children.

    Fact Sheet

    Health Coverage For Low-Income Children This fact sheet profiles the low-income children population, describes sources of health insurance coverage for the population, and summarizes trends and issues about their health coverage. Fact Sheet (.pdf)

  • Louisiana’s Proposed Section 1115 Medicaid Demonstration Project: Estimating the Numbers of Uninsured and Projected Medicaid Costs

    Issue Brief

    This brief analyzes the composition and medical costs of the uninsured in Louisiana after Hurricane Katrina. The estimates in the brief are the first available that are based on a detailed analysis of who the uninsured are in Louisiana, their current medical spending, and what their spending might be under Medicaid. The findings show that expanding Medicaid coverage to Louisiana's uninsured would cost an estimated $2.3 billion in 2006 dollars. It also suggests that many…

  • A Race to the Top: Illinois’s All Kids Initiative

    Report

    A Race to the Top: Illinois’s All Kids Initiative In the summer of 2006, Illinois launched All Kids, the nation’s first universal coverage program for children. Several states have observed Illinois’ experience and are proceeding with their own coverage initiatives. This case study of Illinois' All Kids initiative describes the key features of the program, examines state decisions on program design and highlights some early program experiences. Report (.pdf)