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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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  • The Medicaid Eligibility Maze: Coverage Expands, but Problems Persist

    Report

    This report examines Medicaid eligibility policies and operations in five states - California, Colorado, Florida, Minnesota and Wisconsin - following initial changes introduced by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 and the new Children's Health Insurance Program (CHIP). The study findings suggest that eligibility policy expansions alone may not prevent Medicaid enrollment declines. The report discusses several problem areas affecting Medicaid eligibility and enrollment operations including challenges in severing Medicaid…

  • Tax Subsidies for Health Insurance: Evaluating the Costs and Benefits

    Other Post

    This technical report provides 1) a description of the detailed simulation model and the assumptions used to analyze the effects of different tax subsidies for the purchase of health insurance coverage, and 2) the results of this analysis. The analysis includes the number of people who gain coverage, overall costs to the government, how much is spent on the currently insured vs. uninsured, and the effects on low-income groups. The results of this report were…

  • Comparison of Medi-Cal and Healthy Families Programs for Children in California

    Report

    A new side-by-side examination of California's Medicaid program (Medi-Cal) and CHIP program (Healthy Families) shows how these two low-income health coverage programs differ in structure, eligibility, enrollment process, service delivery and scope. This California case study helps to illustrate differences between Medicaid and CHIP. SIDE-BY-SIDE Download

  • Issues Facing Medicaid and CHIP

    Event Date:
    Event

    Cindy Mann, senior fellow of the Commission, testified to the Senate Subcommittee on Public Health of the Health, Education, Labor and Pensions Committee on how to sustain and expand health care coverage for low-income children and families, and disabled and elderly people in these challenging times. TESTIMONY Download

  • Medicare Prescription Drug Coverage: Facts, Options, and Implications

    Event Date:
    Event

    Testimony by Patricia Neuman, Sc.D., vice president and director of the Foundation's Medicare Policy Project, for the House Committee on Energy and Commerce, Subcommittee on Health, hearing on Creating a Medicare Prescription Drug Benefit: begins with a brief review of existing sources of prescription drug coverage for the Medicare population and a discussion of how the lack of coverage affects people on Medicare. It then reviews broad approaches to improving prescription drug coverage, considers the…

  • The Medicare Program: Servicios De Salud Administrados Por Medicare

    Fact Sheet

    Panorama General: Medicare proporciona servicios de salud a casi 39 millones de norteamericanos, incluyendo aproximadamente a 34 millones de ancianos y a 5 millones de discapacitados. La gran mayoria de estas personas cubren sus gastos medicos directamente mediante el programa tradicional de "pago por servicio," mientras que el 15 porciento restante (mas de 5 millone de beneficiarios) estan cubiertos bajo algun plan de servicio medico contratado con Medicare, principalmente las organizaciones de administracion de la…

  • SCHIP Administration and Accountability

    Report

    The third in a series of reports on implementation issues and challenges in the first year of S-CHIP finds that non-Medicaid S-CHIP programs faced more administrative challenges. Success with enrollment appeared primarily related to administrative decisions, including a lower band of S-CHIP income eligibility, and the lack of premiums. REPORT Download

  • Medicaid’s Role for Low-Income Medicare Beneficiaries

    Fact Sheet

    Medicaid's Role for Low-Income Medicare Beneficiaries An overview that identifies low-income Medicare beneficiaries (dual eligibles), how Medicaid can provide care for them, and the challenges to accessing care. Fact Sheet

  • The Working Uninsured in California and the US

    Issue Brief

    This issue brief, prepared by Linda Blumberg and Len Nichols of the Urban Institute, examines the factors contributing to the disproportionately high rates of uninsurance among California's workers compared to the U.S. The report looks at differences in coverage by race and ethnicity, and by citizenship status, and also examines offer and take-up rates for employer health insurance among California's workers. Issue Brief