Orlando Harmon
In the United States, about 1 in 10 people do not have health insurance. While the Affordable Care Act (ACA) has helped to reduce the number of uninsured people, as of 2023, 8% of Americans were still uninsured. The main reason for this is the high cost of insurance, with 63% of uninsured adults aged 18-64 stating that coverage is unaffordable. This has significant consequences, as uninsured people are less likely to receive the necessary medical care and experience poorer health and earlier deaths. While some states, like Rhode Island and Vermont, have introduced laws recommending or requiring health insurance for residents, the decision to mandate health insurance ultimately depends on various factors, such as state policies, financial assistance, and eligibility criteria.
| Characteristics | Values |
|---|---|
| Percentage of people without health insurance in the US | 8% (26 million people) in 2023 |
| Percentage of uninsured working-age adults (19-64) | 10.9% in 2023 |
| Percentage of uninsured children under 19 | 5.8% in 2023 |
| States requiring residents to have health insurance | New Jersey, California, Rhode Island, Massachusetts, and the District of Columbia |
| States recommending health insurance without a penalty | Vermont |
| Main reason for lacking coverage | High cost of insurance |
| Percentage of uninsured adults facing difficulty affording healthcare costs | 49% |
| Percentage of uninsured adults with healthcare debt | 62% |
| Most common type of health insurance | Employment-based insurance (53.7%) |
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What You'll Learn
In 2023, 8% of Americans were uninsured
In the United States, most people obtain health insurance through their jobs. In 2023, 53.7% of the population was covered by employment-based insurance, a slight decrease from 2022. Private health insurance coverage is more prevalent than public coverage, with 65.4% and 36.3% of the population covered, respectively.
Despite this, in 2023, 8% of Americans, or 26 million people, were uninsured. This figure remained relatively stable compared to 2022, with an uninsured rate of 7.9%. The number of uninsured children increased from 3.8 million in 2022 to 4.0 million in 2023. The uninsured rate for children under the age of 19 increased from 5.4% in 2022 to 5.8% in 2023.
The main reason cited for lacking health insurance coverage is the high cost of insurance. In 2023, 63% of uninsured adults aged 18-64 said that the cost of coverage was too high. Many uninsured people do not have access to coverage through their jobs, and some, especially those in states that have not expanded Medicaid, are ineligible for financial assistance. While over half of uninsured people may be eligible for Medicaid or subsidised coverage, they may face barriers to enrolling or may not be aware of these options.
The implications of being uninsured include unaffordable medical bills and subsequent medical debt. Uninsured people are more likely to delay or avoid seeking healthcare due to cost concerns, which can lead to minor problems becoming more severe and costly to treat.
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High costs are the main reason people lack coverage
In 2023, 26 million people, or 8% of the US population, were uninsured. While this figure represents one of the lowest uninsured rates in history, the high cost of insurance remains the main reason people lack coverage. In 2023, 63% of uninsured adults aged 18-64 cited the high cost of coverage as the reason they lacked insurance. Many uninsured people do not have access to coverage through a job, and some, particularly poor adults in states that have not expanded Medicaid, remain ineligible for financial assistance.
Even with insurance, many people struggle with the high cost of healthcare. About half of US adults say that it is difficult to afford healthcare costs, and one in four say they or a family member in their household had problems paying for health care in the past year. These costs and the prospect of unexpected medical bills rank as the top financial worry for adults and their families. Lower-income and uninsured adults are the most likely to report difficulty in affording healthcare, but those with health insurance and higher incomes are not immune to high medical costs.
The high cost of healthcare is also a burden on insured individuals. About half of insured adults worry about affording their monthly health insurance premiums, and large shares of adults with employer-sponsored insurance rate their insurance as "fair" or "poor" in terms of monthly premiums and out-of-pocket costs to see a doctor. As a result, even with insurance, one in five adults still report not getting the healthcare they need due to cost.
The cost of healthcare in the US is high compared to other large and wealthy countries, with spending on inpatient and outpatient care being the primary driver of higher overall healthcare spending. Consolidation among providers, insurers, and drug manufacturers has contributed to rising healthcare prices, leading to regulatory actions against anticompetitive practices to protect consumers. Despite these efforts, challenges remain in addressing provider charging practices and facility fees.
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Uninsured people often face unaffordable medical bills
In 2023, 26 million people, or 8% of the population, were uninsured, according to a report by the Census Bureau. While the uninsured rate in 2023 was one of the lowest in history, the number still represents a significant portion of the population. Uninsured people often face unaffordable medical bills when they seek care, which can quickly translate into medical debt. This is because most uninsured people have low to moderate incomes and little to no savings. More than six in ten, or 62% of uninsured adults, have medical debt, compared to 44% of insured adults.
The high cost of insurance is the main reason why many lack coverage. In 2023, 63% of uninsured adults aged 18-64 cited the high cost of coverage as the reason for being uninsured. Many uninsured people do not have access to coverage through their jobs, and some, especially poor adults in states that have not expanded Medicaid, are ineligible for financial assistance. Although over half of uninsured people may be eligible for Medicaid or subsidized coverage, they may not be aware of these options or face barriers to enrolling. Even with subsidies, marketplace coverage may not be affordable.
The implications of being uninsured are far-reaching. Uninsured people are less likely to access care and more likely to delay or forgo it altogether due to concerns over costs. They are also nearly five times more likely than insured people to lack a usual source of care. Uninsured people often face higher rates charged by hospitals compared to those paid by private insurers and public programs. This means that those without insurance for an entire calendar year pay for almost 40% of their care out of pocket.
The burden of medical debt is a persistent problem in the United States, affecting even those with insurance. Medical debt is most pronounced among people with disabilities, poor health, financial insecurity, or a combination of these factors. People with complex health needs that require ongoing care can see medical bills pile up over time. They may also experience unemployment or income losses, further impairing their ability to pay.
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Employment-based insurance is the most common type
In 2023, 26 million people, or 8% of the population, were uninsured in the United States. This is a historic low, with the uninsured rate averaging 15% in the decade before the enactment of the Affordable Care Act (ACA) in 2010.
Despite this, private health insurance coverage is more prevalent than public coverage, at 65.4% and 36.3% respectively. Employment-based insurance is the most common type, covering 53.7% of the population for some or all of 2023. This is a decrease of 0.7% from 2022.
Employment-based insurance is often called group health insurance, and it is offered by many employers. These plans differ, ranging from basic coverage to more comprehensive plans. Employers will often provide different plan options, allowing employees to select the type of insurance that best meets their needs. For example, PPO plans are the most common plan type, with broader provider networks and no requirement for gatekeeping for specialist services.
Some types of insurance coverage are mandatory for certain employers, while others are not. Employers with 51 or more employees usually obtain coverage in the large group market. Alternatively, employers can self-insure, which means that they pay employees' medical claims with their own money rather than purchasing coverage from an insurance company.
The high cost of insurance is the main reason many people lack coverage. Nearly half of uninsured adults say they have difficulty affording healthcare costs, and this can quickly translate into medical debt. Employment-based insurance is attractive because the employer often pays a large share of the cost.
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Some states require residents to have health insurance
Health insurance is not mandatory at the federal level in the United States. However, some states have implemented their own individual mandates, requiring residents to have health insurance or face penalties. These include California, Massachusetts, Rhode Island, New Jersey, Vermont, and Washington D.C.
The Affordable Care Act (ACA), also known as Obamacare, was enacted in 2010 and mandated that nearly all Americans have health insurance coverage. This federal mandate was effectively revoked in 2019, and Congress repealed the individual mandate penalty in 2017. Despite this, some states continue to require residents to have health insurance to improve health outcomes and raise funds for reinsurance programs and state-based medical care subsidies.
In California, residents must have either minimum essential coverage or qualify for an official exemption. The state offers a range of qualifying healthcare plans, including some student health plans and Medicare Part A or Part C. Those who do not have health insurance or qualify for an exemption must pay a penalty of at least $900 per adult and $450 per dependent.
Rhode Island also requires all residents to have a qualifying form of health insurance, such as employer-sponsored coverage, Medicare, Medicaid, or MEC purchased from an insurance company or through the state-based Marketplace, HealthSource RI. Rhode Island's individual mandate requires all non-exempt residents to have health insurance, with tax penalties incurred when filing state taxes.
New Jersey has the Health Insurance Market Preservation Act, which requires minimum essential health coverage for all qualifying individuals. Uninsured individuals must pay a tax penalty, known as the Shared Responsibility Payment (SRP), based on household income and family size. Exemptions are available for those with low incomes, experiencing hardship, or lacking affordable coverage options.
Vermont's H.524 medical care bill recommends that all residents over 18 have health insurance coverage, providing access to Vermont Health Connect, its state-based marketplace. However, unlike other states, Vermont does not require residents to pay a penalty for non-compliance.
While the specific regulations vary by state, the overall goal of these individual mandates is to increase the number of people with health insurance coverage, promote better access to healthcare services, and reduce the burden on healthcare systems.
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Frequently asked questions
No. While most Americans have insurance, about 8% of the population, or 26 million people, were uninsured in 2023.
The main reason people are uninsured is the high cost of insurance. In 2023, 63% of uninsured adults aged 18-64 said that the cost of coverage was too high. Many people also don't have access to coverage through their job, and some, particularly in states that have not expanded Medicaid, are ineligible for financial assistance.
Uninsured people often face unaffordable medical bills when they seek care. Nearly half of uninsured adults say they have difficulty affording healthcare costs, and more than six in ten uninsured adults report having healthcare debt. Uninsured adults are also less likely to have a primary care provider and may not be able to afford the healthcare services and medications they need.
Strategies to increase insurance coverage rates are critical to ensuring that more people get important healthcare services. Interventions to increase access to healthcare professionals and improve communication can help more people get the care they need.
New Jersey, California, Rhode Island, Massachusetts, and the District of Columbia require residents to have health insurance or face penalties. Vermont recommends that residents have health insurance, but there is no penalty for non-compliance.
