Uninsured

Data on demographics; health coverage, access, and utilization; and health status by race and ethnicity provides insight into the status of health disparities and changes since implementation of the ACA.

This issue brief describes how coverage has changed in recent years, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage.

A KFF analysis of administrative data suggests that relatively few Americans have lost job-based health insurance amid the economic chaos of the pandemic — and that many who did likely found a safety net in coverage through Medicaid or the Affordable Care Act’s individual market.

Nationally, 2.2 million poor uninsured adults were in the ACA “coverage gap” in 2019 in states that had not expanded Medicaid. They earned too much to be eligible for Medicaid but not enough to qualify for Marketplace premium tax credits. Three-quarters of them reside in just four states: Texas, Florida, Georgia and North Carolina.

Community health centers play a key role in the pandemic, especially in communities with high poverty and high health needs. They’ve adopted new models of care, responded to medical and nonmedical needs, and moved care into new locations and configurations.

Nearly 28 million people in the U.S. lack health insurance. They will likely face unique barriers accessing COVID-19 testing and treatment. And those who contract COVID-19 and need medical care will likely receive large medical bills, even if they have low incomes and are unable to pay.

The Department of Health and Human Services program to pay for care for uninsured Americans with COVID-19 has been in place for about five months, but limits on who is eligible may be leaving some patients with large bills.

More than 7 in 10 community health centers saw an increase in patients with opioid use disorder from 2018 to 2019. Evidence suggests overdoses are rising during the pandemic. Health centers have boosted services and are major source of medication-assisted treatment, but still face challenges meeting the demand.