Paul Sanchez
In the United States, health insurance coverage is not mandatory for citizens, and the rate of uninsured Americans has been steadily increasing over the years. In 2023, the percentage of people without health insurance remained at around 8%. The main reason for lacking coverage is the high cost of insurance. Private health insurance is more prevalent than public coverage, and employment-based insurance is the most common type of health insurance. However, many Americans with insurance still face issues such as medical debt, billing errors, and denials of coverage. This has led to a growing concern about the impact of lacking insurance on Americans' health, with studies suggesting that tens of thousands of preventable deaths occur annually due to a lack of insurance.
| Characteristics | Values |
|---|---|
| Percentage of Americans without health insurance in 2023 | 8% |
| Percentage of Americans without health insurance in 2024 | 9% |
| Main reason for not having health insurance | High cost of insurance |
| Percentage of uninsured adults facing difficulty affording health care costs | 49% |
| Percentage of uninsured adults with health care debt | 62% |
| Percentage of insured adults with health care debt | 44% |
| Percentage of uninsured children who didn't see a doctor in the past year | 27.4% |
| Percentage of children with public coverage who didn't see a doctor in the past year | 4.8% |
| Percentage of children with private coverage who didn't see a doctor in the past year | 3.7% |
| Percentage of uninsured adults who didn't have a regular place to go when they were sick or needed medical advice | 42.8% |
| Percentage of uninsured adults who went without needed care in the past year due to cost | 22.6% |
| Percentage of adults with private coverage who went without needed care in the past year due to cost | 5.1% |
| Percentage of adults with public coverage who went without needed care in the past year due to cost | 7.7% |
| Percentage of uninsured Americans who lost their health insurance due to job loss during the COVID-19 recession | 5.4% |
| Number of preventable deaths due to lack of insurance in 2012 | 48,000 |
| Percentage of young adults aged 18-24 without health insurance in 2007 | 28.1% |
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What You'll Learn
Private insurance is more prevalent than public coverage
In the United States, health insurance coverage is a complex and dynamic issue, with a significant number of people relying on private insurance plans. As of 2023, private health insurance coverage remains more prevalent than public coverage, with 65.4% of people opting for private insurance compared to 36.3% choosing public options. This trend has been consistent, with similar numbers reported in 2022, where 65.6% of people had private insurance, and 36.1% had public coverage.
The subtypes of health insurance coverage vary, but employment-based insurance is the most common form of private insurance, covering 53.7% of the population in 2023. This is a slight decrease from 2022 when it stood at 54.5%. Other subtypes of private insurance include direct-purchase coverage, which has been increasing, and TRICARE. It is important to note that the rates of Medicare and Medicaid, which are public coverage programs, have also been showing growth.
The high cost of insurance is a significant factor contributing to the prevalence of private insurance over public options. In 2023, 63% of uninsured adults aged 18-64 cited the high cost of coverage as the main reason for lacking insurance. This is particularly true for adults in states that have not expanded Medicaid, where they may be ineligible for financial assistance. Even with potential subsidies, Marketplace coverage may still be unaffordable for many. As a result, uninsured individuals often face substantial medical bills and are more likely to delay or forgo necessary healthcare due to financial constraints.
The consequences of being uninsured can be severe, as nearly half of uninsured adults report having healthcare debt. Additionally, uninsured individuals are less likely to have a regular place to seek medical advice or treatment when they are sick, which can lead to preventable conditions or chronic diseases going undetected. These factors contribute to the reliance on private insurance, as people seek more affordable and accessible coverage options.
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Employment-based insurance is the most common type
In the United States, most citizens have to obtain health insurance through their employers, the government, or by purchasing it themselves. In 2023, 92% of Americans had health insurance, with private health insurance coverage being more prevalent than public coverage (65.4% vs 36.3%). Of the subtypes of health insurance coverage, employment-based insurance was the most common type, covering 53.7% of the population for some or all of the year. This is a slight decrease from 2022, when employment-based insurance covered 54.5% of the population.
The current system of voluntary employment-based health benefits in the US is a result of various factors, including innovations in healthcare finance and organisation, conflicting political and social principles, coincidences of timing, and market dynamics. The primary objective of most early insurance initiatives was not reimbursement for medical expenses but protection against the loss of income due to illness or injury. By the beginning of the 19th century, guilds, unions, mutual aid societies, fraternal associations, and other private groups had developed various forms of collective action to protect group members and their families against economic catastrophes, such as the death of the primary breadwinner.
Over time, the focus shifted towards reimbursement for medical expenses. One of the first Blue Cross plans, which began in 1929 and involved Baylor University Hospital and Dallas public school employees, is often cited as the precursor to modern employment-based health insurance in the US. By 1930, plans sponsored by employers, employees, or both, covered an estimated 1.2 million employees and 1-2 million dependents.
Today, employment-based insurance is still the most common type of health insurance in the US, but its prevalence is declining. A report by the Employee Benefits Research Institute (EBRI) predicts that this decline will continue until the economy gains enough strength to substantially impact the labour market. Additionally, employers may reconsider offering health insurance if the value proposition changes or if the costs of adding coverage become too high.
The availability of employment-based insurance also varies based on demographic factors. For instance, EBRI found that Americans with employer-based insurance are more likely to earn more than $75,000 per year, work in managerial or professional occupations, be employed by large firms, and be white.
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High costs are the main reason people lack coverage
In America, the topic of healthcare coverage is a highly debated and complex issue. While the Affordable Care Act (ACA) has expanded access to health insurance, there are still significant numbers of people who lack coverage. High costs are the main reason people lack health insurance coverage in the United States. This is true for both adults and children. In 2023, 63% of uninsured adults aged 18-64 cited the high cost of coverage as the main reason for being uninsured. Similarly, in the same year, 9.5% of uninsured children went without needed care due to costs, compared to 0.7% and 1% of children with private and public insurance, respectively.
The high cost of health insurance in the US is driven by several factors, including the complexity of the system, the lack of regulated pricing, and market forces. The US healthcare system involves multiple tiers of coverage, with separate rules, funding sources, enrollment dates, and out-of-pocket costs for different forms of insurance, such as employer-based, private, or government-provided plans. This complexity makes it challenging for individuals to navigate and understand the true costs of their healthcare. Additionally, the lack of set prices for medical services allows providers to charge varying rates, which are often higher than in other countries. For example, a CT scan in the US can cost $553, compared to $78 in Spain.
The high costs of health insurance and medical care have significant implications for individuals and families. Uninsured people often face unaffordable medical bills when they seek care, leading to medical debt. Lower-income and uninsured adults are the most vulnerable, with 49% of uninsured adults reporting difficulty in affording healthcare costs. Even among insured individuals, about half worry about affording their monthly premiums and out-of-pocket expenses. The burden of healthcare costs also affects healthcare-seeking behavior, with uninsured individuals being less likely to access care and more likely to delay or forgo it due to costs. This can have severe consequences, especially when preventable conditions or chronic diseases go untreated.
While Medicaid and subsidized Marketplace coverage offer financial assistance to those who are eligible, not everyone qualifies or is aware of these options. Additionally, even with subsidies, Marketplace coverage may still be unaffordable for some. Furthermore, individuals in states that have not expanded Medicaid may remain ineligible for financial assistance, further contributing to the challenge of accessing affordable health coverage.
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Uninsured people face unaffordable medical bills
In 2023, 63% of uninsured adults aged 18-64 cited the high cost of coverage as the main reason for not having insurance. Many uninsured people do not have access to coverage through their jobs, and some, especially those in poverty, remain ineligible for financial assistance. While over half of uninsured people may be eligible for Medicaid or subsidised coverage, they may not be aware of these options or face barriers to enrolment.
The consequences of not having insurance can be severe. Uninsured people often face unaffordable medical bills when they seek care, and nearly half (49%) of uninsured adults say they have difficulty affording healthcare costs. These costs can quickly translate into medical debt, as most uninsured people have low or moderate incomes and little to no savings. More than six in ten (62%) uninsured adults report having healthcare debt, and they are more likely to face negative consequences such as using up their savings, borrowing money, or having difficulty paying other living expenses.
Uninsured adults are far more likely than their insured counterparts to postpone or forgo healthcare altogether due to concerns over costs. In 2023, 22.6% of uninsured adults went without needed care in the past year because of cost, compared to 5.1% of adults with private coverage and 7.7% of adults with public coverage. Uninsured children were also more likely than insured children to go without needed care due to cost in 2023 (9.5% compared to 0.7% and 1.0%, respectively). Over a quarter (27.4%) of uninsured children had not seen a doctor in the past year, compared to 4.8% of children with public coverage and 3.7% of those with private coverage.
While federal and state laws require certain hospitals to provide some level of charity care, not all eligible patients benefit from these programs. Charity care costs represent a small share of operating expenses at many hospitals. Research suggests that gaining health coverage improves the affordability of care and financial security among the low-income population. Multiple studies of the ACA found declines in trouble paying medical bills and reductions in medical debt in expansion states relative to non-expansion states.
Medical debt is a persistent problem in the United States, with nearly 1 in 12 adults owing medical debt. People with complex health needs that require ongoing care can see medical bills pile up over time, and those in worse health may also experience unemployment or income losses, further contributing to their difficulty in affording medical bills. Insured patients can also incur medical debt from care that is not covered by insurance, including denied claims and out-of-network care. Many Americans, even those with private health insurance, do not have enough liquid assets to meet deductibles or out-of-pocket maximums.
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Young adults are the most likely to be uninsured
In 2023, the percentage of people in the US without health insurance remained around 8%. While the number of uninsured people in the US has generally decreased over the years, young adults aged 19-34 are the most likely to be uninsured. Between 2018 and 2019, the uninsured rate for this age group increased by 0.4% to 15.6%. The uninsured rate for 19-year-olds was 4.8% higher than that of 18-year-olds in 2019. Similarly, the uninsured rate for 26-year-olds was 3.6% higher than that of 25-year-olds.
There are several reasons why young adults are more likely to be uninsured. Firstly, young adults lose eligibility for public coverage under the Children's Health Insurance Program (CHIP) in most states at age 19. Secondly, young adults are no longer eligible for dependent coverage under their parents' health insurance once they turn 26. This change in eligibility for health coverage at ages 19 and 26 contributes to the higher uninsured rate among young adults.
The high cost of insurance is another significant factor contributing to the lack of coverage among young adults. Many uninsured individuals cite the cost of coverage as the main reason for not having insurance. In 2023, 63% of uninsured adults aged 18-64 stated that they were uninsured due to the high cost of coverage. Additionally, many uninsured people do not have access to coverage through their jobs, and some may be unaware of alternative coverage options or face barriers to enrolling.
Being uninsured can have significant financial implications and impact access to healthcare. Uninsured individuals often face unaffordable medical bills and are more likely to incur medical debt. Nearly half (49%) of uninsured adults reported difficulty affording healthcare costs, which is more than double the rate of those with private insurance (21%). As a result, uninsured adults are more likely to delay or forgo necessary healthcare due to concerns over cost. This can lead to severe consequences, especially when preventable conditions or chronic diseases go untreated.
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Frequently asked questions
No, Americans are not legally obliged to have medical insurance. However, the Affordable Care Act (ACA) mandates that Americans must have “minimum essential coverage” or pay a fine. In 2023, the percentage of people without health insurance remained around 8%.
Uninsured people in the US often face unaffordable medical bills when they seek care. Nearly half of uninsured adults (49%) say they have difficulty affording healthcare costs, and over six in ten (62%) report having medical debt.
Uninsured people in the US are less likely to access healthcare and more likely to delay or forgo it due to costs. A 2009 study found that lack of health insurance is associated with about 45,000 excess preventable deaths per year. By 2012, this number had grown to 48,000 per year.
