Americans With Private Health Insurance: How Many?

In a country without universal healthcare, the number of Americans with private health insurance is a crucial metric. In 2019, 68% of the population had private health insurance coverage at some point during the year, according to the Current Population Survey Annual Social and Economic Supplement (CPS ASEC). This figure is supported by the National Health Interview Survey, which found that 64.4% of people under 65 had private insurance at the time of their interview in 2023.

The percentage of Americans with private health insurance has fluctuated over the years, influenced by policy changes and economic conditions. In 2018, the percentage of people with private coverage was 67.3%, a slight decrease from the previous year. The impact of the Affordable Care Act (ACA) or Obamacare is evident, as the number of uninsured fell between 2013 and 2016 due to expanded Medicaid eligibility. However, the improvements in coverage began to reverse under the Trump administration, with the number of uninsured rising from 27.3 million in 2016 to 29.6 million in 2019.

The availability and affordability of private health insurance in the US continue to be a concern, with the high cost of insurance being a primary reason for the lack of coverage. Despite being an economic powerhouse, the US is the only industrialized nation without universal healthcare coverage, and the consequences of this can be dire, with a lack of health insurance associated with increased mortality.

In 2019, 8.0% of people, or 26.1 million, did not have health insurance

The high cost of insurance is the reason many people do not buy health insurance, despite the creation of the ACA. In fact, around 73% of those who were uninsured in 2019 claimed that it was because of the high cost of health insurance.

The US remains the sole industrialized nation in the world without universal healthcare coverage. Prohibitively high costs are the primary reason Americans give for problems accessing healthcare. The number of people without health insurance coverage in the US is one of the primary concerns raised by advocates of healthcare reform. Lack of health insurance is associated with increased mortality, with an estimated range of 30-90,000 deaths per year, depending on the study.

The percentage of people without health insurance coverage decreased in one state and increased in 19 states between 2018 and 2019. All states and the District of Columbia had a lower uninsured rate in 2019 than in 2010.

Private health insurance coverage was more prevalent than public coverage in 2019, covering 68.0% and 34.1% of the population at some point during the year, respectively. Employment-based insurance was the most common subtype.

Private health insurance coverage was more prevalent than public coverage

In 2019, the United States population was approximately 330 million. Of these, 59 million people aged 65 and above were covered by the federal Medicare program. The remaining 273 million non-institutionalized persons under 65 either obtained coverage from employer-based sources (159 million), non-employer-based sources (84 million), or had no insurance (30 million).

In 2019, 8.0% of people, or 26.1 million, did not have health insurance at any point during the year, according to the Current Population Survey Annual Social and Economic Supplement (CPS ASEC). The percentage of people with health insurance coverage for all or part of 2019 was 92.0%.

The percentage of people with private health insurance coverage remained relatively stable between 2017 and 2018, while the percentage of people with public coverage decreased by 0.4 percentage points.

In 2023, 64.4% of people younger than age 65 had private insurance at the time of interview, compared to 28.6% with public insurance. This trend was also observed among adults aged 18–64, with 68.1% having private insurance and 23.0% with public insurance.

The high cost of insurance is a significant factor contributing to the number of uninsured Americans. In 2019, around 73% of those without insurance cited the high cost as the primary reason.

The lack of health insurance can have adverse consequences on an individual's quality of life and financial well-being. Uninsured individuals often face difficulties in accessing timely medical care and are more likely to incur medical debt in the event of a medical emergency.

Employer-based insurance was the most common subtype

In 2019, the United States population was approximately 330 million, with 273 million non-institutionalized persons under the age of 65. Of these 273 million, 159 million had employer-based health insurance, making it the most common subtype. This means that over half (55.1%) of the US population had employer-based insurance.

The number of people with employer-based insurance has been steadily increasing. In 2019, the percentage of people with employer-provided coverage was 55.4%, up from 55.2% in 2018. This is a slight increase, but an increase nonetheless. This is particularly notable given that the percentage of people with Medicaid coverage decreased to 19.8% in 2019, down from 20.5% in 2018.

The number of people with employer-based insurance is also significantly higher than the number of uninsured people in the US. In 2019, there were 30 million uninsured people, compared to 159 million with employer-based insurance. This disparity is even more evident when looking at the percentage of people with any kind of health insurance coverage, which was 89% in 2019.

The prevalence of employer-based insurance is also evident when looking at specific demographics. For example, in 2018, 55.1% of the population had employer-based insurance for all or part of the calendar year. This percentage is higher than the percentage of people with private (67.3%) or public (34.4%) insurance coverage.

The data shows that employer-based insurance is the most common subtype of health insurance in the US. This is likely due to the fact that employer-based insurance is often more accessible and affordable than other types of insurance. It is worth noting, however, that the number of employers offering health insurance has been declining in recent years due to rising insurance costs. Despite this, employer-based insurance remains the most common subtype of health insurance coverage in the US.

The number of uninsured fell between 2013 and 2016 due to expanded Medicaid eligibility

The Affordable Care Act (ACA) has had a significant impact on reducing the number of uninsured Americans. Between 2013 and 2016, the number of uninsured fell by an estimated 17.8 million, with declines in every state and the District of Columbia. This drop can be attributed to the expansion of Medicaid eligibility, among other factors.

The ACA's coverage expansions, which came into effect in 2014, played a crucial role in reducing the number of uninsured. By 2016, an additional 17.8 million Americans under the age of 65 had health insurance compared to 2013. This decrease was observed across all states and was particularly notable in 47 states, where the uninsured rate for adults aged 19 to 64 fell by at least 5 percentage points.

The expansion of Medicaid eligibility was a significant factor in this decline. States that opted to expand Medicaid saw greater reductions in their uninsured rates, especially among adults with low incomes. From 2013 to 2016, the national uninsured rate among adults aged 19 to 64 with incomes below 200% of the federal poverty level decreased from 38% to 23%, resulting in an estimated 9.9 million more low-income adults with health insurance by 2016.

The impact of Medicaid expansion was evident when comparing expansion and non-expansion states. As of 2024, 40 states and the District of Columbia have expanded Medicaid eligibility, while ten states have not. The uninsured rate among adults with Medicaid-eligible incomes in expansion states dropped by half, from 30% in 2013 to 17% in 2016. In contrast, the uninsured rate in non-expansion states only saw a slight decline, remaining at 35%—twice the rate of Medicaid-eligible adults in expansion states.

The number of uninsured working-age adults and children reached record lows by the end of 2016, thanks to the ACA's coverage expansions. This decrease in uninsured individuals was accompanied by improved access to healthcare, particularly for low-income and minority adults. However, recent policy changes and ongoing challenges, such as the lack of Medicaid expansion in some states, threaten to undo these gains.

The uninsured rate rose from 8.6% in 2016 to 9.2% in 2019

In 2016, the percentage of people in the US without health insurance coverage for the entire calendar year was 8.8%, or 28.1 million people. This decreased slightly to 8.6% according to the American Community Survey (ACS) data. The percentage of people with health insurance coverage for all or part of 2016 was 91.2%. Private health insurance coverage was more prevalent than government coverage, at 67.5% and 37.3% respectively.

In 2019, the percentage of people without health insurance coverage for the entire year was 8.0%, or 26.1 million people. The percentage of people with health insurance coverage for all or part of the year was 92.0%. Private health insurance coverage was again more common than public coverage, at 68.0% and 34.1% respectively.

The increase in the uninsured rate from 2016 to 2019 is particularly notable given that it occurred during a period of significant economic growth and falling unemployment. Typically, one would expect the uninsured rate to remain stable or decline under these economic conditions. The increase is, therefore, a cause for concern and indicates that other factors, such as policy changes, may have had a significant impact on the number and share of Americans without health insurance coverage.

The increase in the uninsured rate between 2016 and 2019 is also noteworthy because it represents an erosion of the historic gains in insurance coverage achieved under the Affordable Care Act (ACA). The ACA had led to a significant reduction in the number of uninsured individuals, with the uninsured rate falling from 15.5% in 2010 to 8.6% in 2016. The increase in the uninsured rate between 2016 and 2019, therefore, represents a step backward in terms of ensuring access to health insurance coverage for all Americans.

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