Healthcare Insurance: Who's Left Out?

In early 2023, approximately 6.3 million people in the US gained health coverage since 2020, coinciding with the Biden-Harris Administration taking office. The national uninsured rate reached an all-time low of 7.7% in early 2023, a significant decline from 2020. This is encouraging progress, yet it still means that about 1 in 10 people in the US don't have health insurance. The pandemic-era coverage protections and a strong job market contributed to the decline in the uninsured rate. However, with the end of the Medicaid continuous enrollment provision, it is likely that recent coverage gains will reverse.

The number of uninsured people in the US dropped by 5.6 million from 2019 to 2022

The overall number of uninsured Americans decreased from 33.2 million in 2019 to 27.6 million in 2022. Among working-age Americans (those aged 18-64), 12.2% did not have health insurance in 2022, a decrease from 14.7% in 2019. The decrease in the number of uninsured people was driven by an increase in employer-sponsored, Medicaid, and non-group coverage among nonelderly adults. The percentage of people covered by private health insurance increased, and more than a quarter were covered by public health insurance in 2022.

The drop in the number of uninsured people was particularly significant for non-elderly American Indian and Alaska Native and Hispanic people, who experienced larger gains in coverage compared to their White counterparts. However, racial and ethnic disparities in coverage persist, with Hispanic and White people comprising the largest shares of the non-elderly uninsured population. Additionally, adults in non-Medicaid expansion states were twice as likely to be uninsured compared to those in Medicaid expansion states in 2022.

Despite the overall decrease in the number of uninsured people, the high cost of insurance remains a barrier for many. In 2022, 64% of uninsured nonelderly adults cited the cost of coverage as the main reason for lacking insurance. The availability of public coverage also varies across states, with nonelderly adults more likely to be uninsured than children.

8.3% of people in the US, or 27.2 million, did not have health insurance in 2021

In 2021, 8.3% of people in the US, or 27.2 million, did not have health insurance. This figure represents a decrease in the percentage and number of uninsured people from 2020, when 8.6% of people (28.3 million) were without health insurance.

The number of uninsured people in the US has been steadily decreasing since 2010, when 46.5 million nonelderly individuals were uninsured. The percentage of uninsured people in the US dropped to 9.6% in 2022, a record low, with 25.6 million nonelderly individuals lacking health insurance. This is a decrease of 1.9 million from 2021, and 3.3 million from 2019.

The decrease in the number of uninsured people can be attributed to the coverage expansions put in place by the Affordable Care Act (ACA), including Medicaid expansion and subsidized Marketplace coverage. These policies served as a safety net for people who lost their jobs or experienced other economic difficulties during the coronavirus pandemic.

Despite these improvements, racial and ethnic disparities in coverage persist. For example, in 2022, more than one in four Hispanic adults ages 18-64 (27.6%) lacked health insurance, a greater percentage than Black, non-Hispanic adults (13.3%), White, non-Hispanic adults (7.4%), and Asian, non-Hispanic adults (7.1%). Additionally, adults living in non-Medicaid expansion states were twice as likely to be uninsured compared to those in Medicaid expansion states.

People without insurance are less likely to have a primary care provider

People without health insurance are less likely to have a primary care provider. This is because they may not be able to afford the health care services and medications they need. In the US, about 1 in 10 people do not have health insurance.

People without insurance are more likely to delay or forgo care due to costs. They are less likely to receive preventive care and services for major health conditions and chronic diseases. For example, uninsured people are less likely to receive flu shots, blood pressure screenings, and cancer screenings. They are also less likely to have a regular place to go when they are sick or need medical advice. This can lead to more serious health problems that require hospitalization.

The lack of a primary care provider can also result in people not receiving recommended health care services, such as cancer screenings. It can also be due to living too far away from health care providers. Interventions to increase access to health care professionals and improve communication can help more people get the care they need.

The high cost of insurance is the main reason why many people are uninsured. In 2022, 64% of uninsured nonelderly adults in the US cited this as the reason for lacking coverage. Other reasons include not being eligible for coverage (28.4%), not needing or wanting coverage (26.1%), and signing up being too difficult (22.2%).

The number of nonelderly uninsured individuals in the US has been decreasing in recent years. In 2022, there were 25.6 million nonelderly uninsured people, a decrease from 27.5 million in 2021 and 33.2 million in 2019. This decrease is partly due to coverage expansions put in place by the Affordable Care Act (ACA) and pandemic-era policies such as continuous enrollment for Medicaid enrollees and enhanced Marketplace subsidies.

Most uninsured people are in low-income families, with at least one worker in the family. Nonelderly adults are more likely to be uninsured than children, and racial and ethnic disparities in coverage persist. Undocumented immigrants are also ineligible for federally funded coverage.

Uninsured people often face unaffordable medical bills

In 2022, there were 25.6 million nonelderly uninsured people in the US, a decrease of 3.3 million from 2019. The uninsured rate also decreased from 10.2% in 2021 to a record low of 9.6% in 2022. Despite this, about one in ten people in the US don't have health insurance.

Uninsured people are less likely to receive preventive care and services for major health conditions and chronic diseases. They are also more likely to be hospitalized for avoidable health problems and to experience declines in their overall health. When hospitalized, they receive fewer diagnostic and therapeutic services and have higher mortality rates than those with insurance.

The financial implications of being uninsured can be severe. Uninsured people often face unaffordable medical bills, which can lead to medical debt and negative consequences such as using up savings, difficulty paying living expenses, or borrowing money. Unaffordable medical bills can also lead to difficult sacrifices, such as eating less, changing housing situations, or increasing work hours to pay off debt.

The issue of unaffordable medical bills for the uninsured is a critical one that needs to be addressed to ensure that people have access to the healthcare services they need. Strategies to increase insurance coverage rates are crucial to improving access to healthcare and reducing the financial burden on individuals and families.

The uninsured rate among children under 19 decreased by 0.6% from 2020 to 2021

In 2021, the number of children under 19 without health insurance fell to 3.9 million, according to the US Census Bureau. This was a decrease of 475,000 from the previous year, when 4.3 million children under the age of 19 were without health coverage. The uninsured rate among children decreased by 0.6% from 2020 to 2021, driven by an increase in public coverage such as Medicaid and the Children's Health Insurance Program (CHIP).

The decrease in the uninsured rate among children is particularly significant given that the overall number of nonelderly uninsured individuals in the US has been decreasing since the implementation of the Affordable Care Act (ACA). The ACA's coverage expansions, including Medicaid expansion and subsidized Marketplace coverage, served as a safety net for people who lost their jobs or experienced other economic disruptions during the coronavirus pandemic. The number of nonelderly uninsured individuals dropped from 27.5 million in 2021 to 25.6 million in 2022, and the uninsured rate decreased from 10.2% in 2021 to a record low of 9.6% in 2022.

The decrease in the uninsured rate among children is also notable because nonelderly adults are more likely to be uninsured than children. This is largely due to the broader availability of Medicaid and CHIP coverage for children compared to adults. In 2022, the uninsured rate among nonelderly adults was 11.3%, more than double the uninsured rate among children, which was 5.1%.

The decrease in the uninsured rate among children is a positive development, as it means that more children have access to the health care services they need. Strategies to increase insurance coverage rates are critical for ensuring that more people receive important health care services, such as preventive care and treatment for chronic illnesses.

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