Insured People: How Many?

In 2022, nearly 304 million people in the United States had some form of health insurance, a significant increase from the 257 million insured people in 2010. However, there were still over 25 million people in the US without any kind of health insurance. The US does not have universal health insurance, and healthcare costs are covered through a mix of private and public insurance programs. In 2021, almost 50% of the insured population of the US were insured through their employers, while 18.9% were insured through Medicaid, and 15.4% through Medicare.

How many people are uninsured?

In 2022, 25.6 million nonelderly individuals in the US were uninsured, a decrease of 3.3 million from 2019. This equates to 9.6% of nonelderly people, a record low. The number of uninsured people continued a downward trend in 2022, dropping by nearly 1.9 million from 27.5 million in 2021.

The uninsured rate among working-age adults aged 19-64 decreased by 0.8 percentage points to 10.8% between 2021 and 2022. In 2022, 12.2% of working-age Americans (those aged 18-64) did not have health insurance, a decrease from 14.7% in 2019.

In 2023, the national uninsured rate reached an all-time low of 7.7% for US residents of all ages in the first quarter (January-March). Approximately 6.3 million people have gained coverage since 2020, including 5.5 million adults aged 18-64 and 0.7 million children aged 0-17.

The uninsured rate among children was 5.1% in 2022, less than half the rate among nonelderly adults (11.3%). In 2021, the uninsured rate among children under the age of 19 was 5.0%.

Most of the nonelderly people who are uninsured are adults in working, low-income families, and are people of colour. In 2022, 73.3% of the total nonelderly uninsured population had at least one full-time worker in their family, and 80.8% were in families with incomes below 400% of the Federal Poverty Level (FPL). People of colour made up 45.7% of the nonelderly US population but accounted for 62.3% of the total nonelderly uninsured population.

Who is uninsured?

In the US, nearly 13% of drivers do not have auto insurance, according to the Insurance Information Institute. In some states, the number of uninsured drivers is over 20%. Mississippi has the highest proportion of uninsured drivers, at 29.4%, followed by Michigan, Tennessee, New Mexico, and Washington. New Jersey has the lowest percentage of uninsured motorists, with 3.1%.

Uninsured motorist coverage is a component of an auto insurance policy that provides coverage when you are in an accident with another driver who does not have insurance. This type of insurance pays for injuries to you and your passengers, and sometimes for damage to your vehicle. It is mandatory in many states and highly recommended for all drivers.

Underinsured motorist coverage helps protect you if you are in an accident with someone whose policy limits aren't high enough to cover the damage to your vehicle and your medical bills. This type of coverage is also mandatory in many states and is usually offered alongside uninsured motorist coverage.

If you do not have uninsured or underinsured motorist coverage, you could be responsible for covering accident-related expenses out of your own pocket.

Why are people uninsured?

The number of uninsured people in the US has been fluctuating over the years. In 2018, an estimated 30.4 million people were uninsured, up from 28.6 million in 2016. In 2021, the number of uninsured people decreased to 27.2 million, and in 2022, the number further decreased to 25.6 million.

Despite policy efforts to improve the affordability of coverage, the high cost of insurance remains a key reason why many are uninsured. In 2022, 64% of uninsured non-elderly adults cited the high cost of coverage as the main reason for lacking insurance. Many uninsured people do not have access to coverage through their jobs, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage.

Undocumented immigrants are also ineligible for federally funded coverage, including Medicaid and Marketplace coverage. In 2022, nearly three-quarters of the non-elderly uninsured population had at least one full-time worker in their family, and over 80% had incomes below 400% of the federal poverty level. People of colour made up 62.3% of the total non-elderly uninsured population, with Hispanic and White people comprising the largest shares at 40% and 37.7%, respectively.

Non-elderly adults are more likely to be uninsured than children, largely due to the broader availability of Medicaid and CHIP coverage for children than for adults. In 2022, the uninsured rate among children was 5.1%, less than half the rate among non-elderly adults (11.3%). Racial and ethnic disparities in coverage persist, with non-elderly Hispanic and American Indian and Alaska Native people more than 2.5 times more likely to be uninsured than White people.

Medicaid eligibility varies across states, and eligibility for adults is limited in states that have not expanded Medicaid. As of December 2023, 41 states, including Washington, D.C., had adopted the Affordable Care Act (ACA) Medicaid expansion, although only 39 states had implemented the expansion in 2022. In states that have not expanded Medicaid, the median eligibility level for parents is just 37% of the federal poverty level, and adults without dependent children are mostly ineligible.

In addition, millions of poor uninsured adults fall into a "coverage gap" because they earn too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Many lawfully present immigrants must also meet a five-year waiting period after receiving qualified immigration status before they can qualify for Medicaid, further contributing to the uninsured population.

What are the health implications of being uninsured?

Being uninsured has a negative impact on health and can lead to premature death from preventable causes. Uninsured individuals are less likely to receive preventive and screening services and are more likely to delay or forgo care due to costs. They also face unaffordable medical bills when they do seek care, which can quickly lead to medical debt. Uninsured individuals have less access to recommended care, receive poorer quality of care, and experience worse health outcomes than insured individuals. They are less likely to receive timely diagnosis and treatment, which can lead to more severe health issues and complications.

Uninsured individuals with specific conditions, such as hypertension, high cholesterol, diabetes, cardiovascular disease, and mental illness, are at an increased risk of adverse health outcomes due to lack of access to appropriate care and treatment. They may experience uncontrolled blood sugar levels, higher mortality rates, and a decline in overall health and physical functioning.

Uninsured individuals are also more likely to be hospitalized and have higher in-hospital mortality rates than insured individuals. They receive fewer services, have higher rates of adverse medical events due to negligence, and are more likely to experience avoidable health problems and declines in overall health.

Overall, the lack of health insurance has significant health implications and can lead to premature death, worse health outcomes, and financial burdens for individuals and families.

What are the financial implications of being uninsured?

Being uninsured can have significant financial implications for individuals and families. Uninsured people often face unaffordable medical bills, which can quickly lead to medical debt, especially for those with low or moderate incomes and limited savings. In addition, they may be charged higher rates for hospital services compared to insured patients. As a result, uninsured individuals are more likely to have problems paying medical bills and may face negative consequences such as using up savings, difficulty paying for essentials, or borrowing money.

Uninsured people typically have to pay a larger proportion of their medical costs out-of-pocket compared to those with insurance, even though their overall medical spending is lower. This is because they do not have insurance to cover a significant portion of the expenses. In 2014, uninsured individuals who used medical services paid an average of $752 out of pocket, compared to $658 for those with private insurance and $236 for those with public coverage.

The cost of uncompensated care for the uninsured is substantial, and while there are funds to help providers defray these costs, they do not fully offset the burden. Hospitals and providers bear a significant portion of these costs, which can impact their financial situation.

Furthermore, being uninsured can affect an individual's ability to access health care services. They may delay or forgo care due to costs, leading to potential health complications and negative long-term consequences.

Frequently asked questions