Haris Ashley
In 2022, 8% of the US population, or 26 million Americans, did not have health insurance. While the Affordable Care Act (ACA) has allowed millions to choose a government-subsidized healthcare plan, many are ineligible for subsidies, and some who qualify have opted out. The main reason many people are uninsured is that they cannot afford coverage. Uninsured adults are more likely to go without needed care than their insured counterparts. They are also at risk of large medical debts, which contribute to a large number of bankruptcies in America.
| Characteristics | Values |
|---|---|
| Number of uninsured Americans in 2022 | 26 million |
| Percentage of uninsured Americans in 2022 | 8% |
| Percentage of uninsured adults with medical or dental debt | 80%+ |
| Average debt of uninsured adults | $500+ |
| Percentage of uninsured adults with debt over $5000 | 22% |
| Primary source of debt | Hospital care |
| Uninsured adults who did not see a doctor in the past year | 46.6% |
| Percentage of insured adults who did not see a doctor in the past year | 15.6% |
| Uninsured adults who did not see a doctor due to cost | 22.6% |
| Percentage of insured adults who did not see a doctor due to cost | 5.1% |
| Percentage of people uninsured for more than a year | 64% |
| Primary reason for being uninsured | Lack of access to affordable health coverage |
| Percentage of uninsured adults with a chronic illness | 49% |
| Uninsured individuals who are exempt from paying a tax penalty | 100% |
| Number of uninsured adults in 2024 | 27.1 million |
| Percentage of uninsured adults in 2024 | 8.2% |
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What You'll Learn
The financial risks of going without medical insurance
While there is currently no tax penalty for not having health insurance, there are still financial risks associated with being uninsured. According to data from the US Census, 8% of the US population, or 26 million Americans, did not have health insurance in 2022. The main reason many people are uninsured is the lack of access to affordable health coverage.
Health insurance can help reduce your risk of racking up medical debt. Uninsured people often face unaffordable medical bills when they seek care. Nearly half (49%) of uninsured adults say they have difficulty affording healthcare costs, compared to 21% of those with private insurance. These costs can quickly translate into medical debt since 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, compared to 44% of insured adults.
Without insurance, you may be more likely to delay or forgo necessary healthcare due to the cost. In 2023, nearly half (46.6%) of uninsured adults aged 18 to 64 reported not seeing a doctor or healthcare professional in the past 12 months, compared to 15.6% with private insurance and 14.2% with public coverage. This delay or lack of care can lead to more severe health issues over time and negatively affect your health.
While it may be tempting to go without insurance and take your chances, it is a gamble that may not be worth the risk. The potential financial implications of being uninsured can be significant. For example, a hospital stay for just a few days, estimated at $11,600 per night by Milliman, could quickly push someone to the financial brink. Even the cheapest insurance plans can provide essential services, such as free preventive care, which could save money in the long run.
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The impact of unaffordable medical insurance on health
One of the main consequences of unaffordable medical insurance is delayed or forgone healthcare. Uninsured adults are more likely to go without needed medical care than those with insurance. In 2023, nearly half (46.6%) of uninsured adults aged 18 to 64 reported not seeing a doctor or healthcare professional in the past year, compared to much lower rates among those with private or public insurance. Cost is a significant factor, with over one-fifth (22.6%) of uninsured adults citing financial reasons for not accessing care. Even among insured adults, cost can be a barrier, with 15% of those with healthcare debt being denied care due to their inability to pay.
The financial burden of medical care can lead to significant medical debt for those without insurance. Uninsured individuals often face unaffordable medical bills when they seek care, and these costs can quickly accumulate into debt. More than six in ten (62%) uninsured adults report having healthcare debt, compared to 44% of insured adults. Additionally, nearly two-thirds (64%) of adults with medical debt put off or postponed needed healthcare, and half (51%) did not receive recommended medical tests or treatments due to cost.
Overall, the lack of affordable health coverage can lead to delayed or forgone healthcare, increased medical debt, and worse health outcomes for those without insurance. While exemptions from fees for not having health insurance have ended in some places, such as in 2018, the financial burden of medical care can still be a significant challenge for many individuals and families.
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The number of people without medical insurance
The decline in the uninsured rate can be attributed to several factors, including the expansion of Medicaid and Marketplace coverage. The Affordable Care Act (ACA), enacted in 2010, enabled states to expand Medicaid eligibility and establish health insurance marketplaces, contributing to a significant decrease in the share of uninsured people. The continuous enrollment provision during the COVID-19 pandemic also played a role, as states were required to keep people enrolled in Medicaid, resulting in increased enrollment in public health insurance programs.
Despite these gains, disparities persist, with adults aged 19-64 more likely to be uninsured than children. In 2023, the number of uninsured children increased to 4 million, up from 3.8 million in 2022. Additionally, racial and ethnic disparities in coverage remain, and the high cost of insurance continues to be the main reason many people are uninsured. Nearly half of uninsured adults report difficulty affording healthcare costs, often resulting in medical debt.
The consequences of being uninsured can be significant. Uninsured adults are more likely to forgo needed care due to cost, and they may not have a regular place to go when they are sick or need medical advice. This can lead to delays in seeking treatment, potentially impacting their health. Additionally, without insurance, people are at a higher risk of incurring large medical debts, as they are responsible for the full cost of any medical services they receive.
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The reasons people are uninsured
While more than 92% of the U.S. population has health insurance, there were still 26 million Americans (8%) who didn't have health insurance in 2022. The main reason for this is the high cost of insurance. In 2023, 63% of uninsured adults aged 18-64 cited the cost of coverage as the reason they lacked insurance. This figure increases with age, from 66.8% among those aged 18-29 to 80.9% among those aged 50-64.
Hispanic adults (30.4%) are more likely than non-Hispanic white adults (22.3%) to be uninsured due to ineligibility. Men (26.8%) are more likely than women (14.6%) to be uninsured because they feel they do not need coverage. Adults in fair or poor health (17.6%) are more likely to be uninsured than adults in excellent, very good, or good health (14.1%).
Many uninsured people do not have access to coverage through their jobs, and some, especially those in states that have not expanded Medicaid, remain ineligible for financial assistance. While 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.
Uninsured people are less likely to access healthcare and more likely to delay or forgo it due to costs. In 2023, 46.6% of uninsured adults aged 18-64 reported not seeing a doctor or healthcare professional in the past year, compared to 15.6% with private insurance and 14.2% with public coverage. Uninsured people are at higher risk of dying prematurely from preventable causes.
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The legal rights of those without medical insurance
While health insurance is not mandatory at the federal level, going without it can leave you vulnerable to high medical costs in the event of illness or injury. Uninsured adults are more likely to go without necessary care than those with insurance. In 2023, almost half (46.6%) of uninsured adults aged 18 to 64 reported not seeing a doctor or healthcare professional in the previous 12 months, compared to 15.6% with private insurance and 14.2% with public coverage.
If you live in a state with an individual mandate, you must comply with the law to avoid penalties. Only a few states enforce financial penalties for lacking health insurance, but it is still advisable to have financial protection. The fee for not having health insurance, sometimes called the "Shared Responsibility Payment" or "mandate," ended in 2018, meaning you no longer pay a tax penalty for not having health coverage. However, depending on where you live, you may still have to pay a penalty on your income tax.
If you require medical care and lack health insurance, you will have to pay for it out of pocket, which can be exorbitantly expensive. Many people have had to declare bankruptcy due to their medical bills. Therefore, it is essential to explore health insurance options that meet your needs and budget. Most people without health insurance say that unaffordability is the reason they are uninsured. Affordable ways to get health insurance include being added to a spouse's health plan, obtaining a subsidised plan through the Affordable Care Act (ACA) marketplace at HealthCare.gov, or applying for Medicaid if you qualify.
If you do not have insurance or choose not to use it, providers must give you a good faith estimate of how much your care will cost. You will receive the estimate when you schedule care at least three business days in advance or if you request one. You can dispute a bill if it is at least $400 more than the estimate. An independent third party will review the bill and determine an appropriate payment. You must initiate the dispute within 120 days of receiving your initial bill.
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Frequently asked questions
Not having health insurance can lead to large debts, as individuals are at risk of racking up medical debt. It may also affect your health if you delay care due to the cost. In addition, doctors have the right to refuse patients without insurance or who are unable to pay out-of-pocket expenses.
Since 2018, there has been no tax penalty for not having health insurance. However, some states have their own mandates and penalties, so you may face a fee if you live in one of these states without coverage.
Affordable ways to get health insurance include being added to a spouse's health plan, getting a subsidized plan through the Affordable Care Act (ACA) marketplace, or applying for Medicaid if you qualify.
In most cases, providers and facilities must give you a good faith estimate when you schedule care at least 3 business days in advance, or if you request one. If the bill is at least $400 more than the good faith estimate, you can dispute it.
