Haris Ashley
In 2023, 26 million people in the US, or 8% of the population, were living without medical insurance. While this figure represents a significant portion of the population, it is one of the lowest rates in history. The high cost of insurance is the main reason that people lack coverage, with many unable to afford their share of premiums or ineligible for financial assistance. This means that millions of Americans are delaying or forgoing healthcare due to concerns over cost.
| Characteristics | Values |
|---|---|
| Number of Americans without health insurance in 2023 | 26 million |
| Percentage of Americans without health insurance in 2023 | 8%% |
| Percentage of Americans without health insurance in 2022 | 7.9% to 8% |
| Percentage of working-age Americans without health insurance in 2023 | 11% |
| Percentage of Hispanic adults without health insurance in 2023 | 25% |
| Percentage of Black, non-Hispanic adults without health insurance in 2023 | 10.1% |
| Percentage of White, non-Hispanic adults without health insurance in 2023 | 6.9% |
| Percentage of Asian, non-Hispanic adults without health insurance in 2023 | 2.7% |
| Percentage of uninsured adults who didn't see a doctor in the past year | 46.6% |
| Percentage of insured adults with private coverage who didn't see a doctor in the past year | 15.6% |
| Percentage of insured adults with public coverage who didn't see a doctor in the past year | 14.2% |
| Percentage of uninsured adults who didn't see a doctor due to cost | 22.6% |
| Percentage of insured adults with private coverage who didn't see a doctor due to cost | 5.1% |
| Percentage of insured adults with public coverage who didn't see a doctor due to cost | 7.7% |
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What You'll Learn
The percentage of uninsured Americans in 2023 was 8% or 26 million people
In 2023, 8% of Americans, or 26 million people, lacked health insurance. This figure represents a significant portion of the population, yet it is one of the lowest uninsured rates in history. The number of uninsured people in the US has been steadily decreasing over the past decade, with the uninsured rate averaging 15% in the ten years before the enactment of the Affordable Care Act (ACA) in 2010.
The continuous enrollment provision, which played a crucial role in maintaining health coverage during the pandemic, ended on March 31, 2023. States resumed disenrolling people from Medicaid, but the full effects of these disenrollments were not felt until after 2023. Despite this, the number of people without health insurance in 2023 remained relatively unchanged from the previous year, with an uninsured rate of 7.9% in 2022.
The uninsured rate varies across different demographic groups. Among working-age Americans (those aged 18-64), 11% lacked health insurance in the first quarter of 2023, a record low. Additionally, the share of children without insurance increased from 5.1% in 2022 to 5.3% in 2023, or 4 million children. Adults in non-Medicaid expansion states were twice as likely to be uninsured compared to those in Medicaid expansion states in 2022.
The high cost of insurance is a significant factor in why many Americans remain uninsured. In 2023, 63% of uninsured adults aged 18-64 cited the cost of coverage as the main reason for lacking insurance. 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 proportion of those with private insurance (21%).
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High costs are the main reason people lack coverage
The percentage of people without health insurance in the United States remained around 8% in 2023, but rates varied by age and poverty level. High costs are the main reason people lack health insurance coverage. In 2023, 63% of uninsured adults aged 18–64 said they lacked coverage because the cost of insurance was too high. Many uninsured people do not have access to coverage through their jobs, and some, especially poor adults 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 for some, and few can afford private coverage without financial assistance.
The high cost of healthcare is a burden for many US families, and healthcare costs factor into decisions about insurance coverage and care-seeking. These costs and the prospect of unexpected medical bills rank as the top financial worries for adults and their families. About half of US adults say it is difficult to afford healthcare costs, and one in four say they or a family member had problems paying for healthcare in the past year. Lower-income and uninsured adults are the most likely to report difficulty affording healthcare, but those with health insurance and higher incomes are not immune to high medical costs. About six in ten Black and Hispanic adults report difficulty affording healthcare costs, compared to about four in ten White adults.
The cost of prescription drugs also prevents some people from filling prescriptions, with one in five adults saying they have not filled a prescription due to cost. A similar proportion have instead opted for over-the-counter alternatives, while about one in ten have cut pills in half or skipped doses in the last year because of the cost. Many 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.
High out-of-pocket costs and deductibles force many insured people to skip needed care or take on medical debt. Up to one-third of people with chronic conditions like heart failure and diabetes say they skip medication doses or don't fill their prescriptions because of the cost. Two out of five adults who reported they had delayed or skipped getting needed care because of costs said a health problem had gotten worse as a result. People in poor health or dealing with a chronic health condition reported among the highest rates of worsening health due to delayed care. Many people across the insurance system, both public and private, have plans that don't provide them with the cost protection needed to get timely care.
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Uninsured people are less likely to access healthcare
The percentage of people without health insurance in the United States remained around 8% in 2023, with 25.3 million people ages 0-64 uninsured. The number of uninsured children increased from 3.8 million in 2022 to 4 million in 2023, with a rate of 5.8% for children under the age of 19. The main reason for lacking coverage is the high cost of insurance, with 63% of uninsured adults aged 18-64 citing this as the reason for their lack of insurance. Many uninsured people do not have access to coverage through their jobs, and some, especially in states that have not expanded Medicaid, are ineligible for financial assistance.
Research demonstrates that gaining health insurance improves access to healthcare and reduces the adverse effects of being uninsured. For example, a study of a Medicaid expansion in Oregon found that adults who gained coverage were more likely to have outpatient visits and receive prescriptions, and they experienced improved mental health. Similarly, a large body of research on the impact of Medicaid expansion under the Affordable Care Act (ACA) shows that gains in coverage positively impact access to care and the utilization of health services.
Despite the availability of financial assistance under the ACA, some individuals remain outside its reach. About four in ten uninsured people are not eligible due to their state's failure to expand Medicaid, their immigration status, or their access to an affordable Marketplace plan or employer coverage. These disparities in coverage contribute to unequal health outcomes, and policymakers must address them to ensure comprehensive coverage for all.
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Underinsured people may skip necessary treatment due to cost
The percentage of people without health insurance in the United States remained around 8% in 2023, according to the US Census Bureau. However, this figure does not account for the underinsured—those facing high out-of-pocket costs and deductibles that may cause them to skip necessary treatment. Nearly one in four US adults have health coverage all year but are underinsured, and up to one-third of people with chronic conditions like heart failure and diabetes say they skip medication doses or don't fill their prescriptions because of the cost.
The high cost of insurance is the main reason many people are uninsured. In 2023, 63% of uninsured adults aged 18–64 said that they lacked coverage because the cost was too high. Many do not have access to coverage through their job, and some, especially poor adults in states that have not expanded Medicaid, are ineligible for financial assistance. Even with subsidies, marketplace coverage may not be affordable for some.
People without insurance are less likely to access care and more likely to delay or forgo it due to costs. In 2023, nearly half (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. Over one in five (22.6%) adults without coverage said they went without needed care in the past year because of the cost, compared to 5.1% of adults with private coverage and 7.7% of adults with public coverage. Uninsured people are also more likely to skip preventive services and report not having a regular source of healthcare.
The ACA has led to significant growth in the number of health centres and their service capacity through new grant funds and new patient revenues due to expanded coverage. However, this impact has been more limited in states that have not expanded Medicaid, and health centres in all states report that securing needed specialty care for uninsured patients is challenging.
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Public vs private insurance coverage
The percentage of people without health insurance in the United States remained around 8% in 2023, but rates varied by age and poverty level. Nearly two-thirds (64%) of people who were uninsured in 2023 had been without coverage for over a year. The main reason cited for a lack of insurance coverage is its high cost. 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 in states that have not expanded Medicaid, remain ineligible for financial assistance.
Public health insurance is designed to provide coverage for those who cannot afford private insurance or do not meet the qualifications for government insurance. Public health insurance is more affordable than private insurance, as it has lower administrative costs and often requires no co-pays or deductibles. However, it is also less flexible, as policyholders are given a limited selection of medical service providers, and many medical establishments still refuse to accept government-sponsored plans. Therapy may also not be reimbursed by public insurance, even if it is deemed necessary.
Private health insurance, on the other hand, is provided by private companies and is often offered by employers. It can also be purchased by individual consumers. Private insurance is more expensive, as it requires the payment of monthly or yearly premiums, which may not be affordable for everyone. However, it offers more flexibility in terms of coverage and the choice of medical service providers.
Medicare is a federal social insurance program for seniors aged 65 and over and certain disabled individuals. In November 2021, 78.9 million people were covered by Medicare. The Affordable Care Act has taken steps to reduce the burden on Medicare, as the aging population will lead to increased costs. Medicaid, which is funded by both federal and state governments, covers low-income individuals and families, especially children. In 2021, it covered millions of very low-income children and their families. The Affordable Care Act expanded Medicaid eligibility to include individuals with an income under 133% of the federal poverty level who do not qualify for Medicare.
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Frequently asked questions
In 2023, 26 million people in the US, or 8% of the population, were uninsured. This is one of the lowest rates in history, with the uninsured rate averaging 15% in the decade before the enactment of the Affordable Care Act (ACA) in 2010.
The high cost of insurance is the main reason people lack coverage. In 2023, 63% of uninsured adults aged 18-64 said that they were uninsured because the cost of coverage was too high. Many people do not have access to coverage through their jobs, and some, especially poor adults in states that have not expanded Medicaid, remain ineligible for financial assistance.
Uninsured adults are less likely to access healthcare and more likely to delay or forgo it due to costs. In 2023, nearly half (46.6%) of uninsured adults aged 18-64 did not see a doctor or healthcare professional in the past 12 months, compared to 15.6% with private insurance and 14.2% with public coverage.
