Uninsured Globally: A Large Number Unprotected

It is estimated that around 44 million people in the United States do not have health insurance, with a further 38 million having inadequate health insurance. This means that approximately one-third of Americans do not have the security of knowing that medical care will be available to them and their families if and when they need it. The lack of health insurance often leads to people postponing necessary care and forgoing preventive measures such as childhood immunisations and routine check-ups. As a result, those without insurance are more likely to be hospitalised for health conditions that could have been avoided, leading to higher healthcare costs for everyone.

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

Globally, there are millions of people who do not have insurance. While I wasn't able to find the most recent data on the number of uninsured people globally, I did find that in the US, the number of uninsured people decreased by 5.6 million from 2019 to 2022.

The decrease in the number of uninsured people in the US can be attributed to the coverage expansions put in place by the Affordable Care Act (ACA) and pandemic-era policies. The ACA's continuous enrollment provision in Medicaid and enhanced subsidies in the Marketplace helped protect people with low incomes against coverage losses. Additionally, the pandemic-era policies, such as the Families First Coronavirus Response Act (FFCRA), which required states to keep people enrolled in Medicaid, further contributed to the decline in the uninsured rate.

In 2022, 92.1% of people in the US had health insurance, an increase from 91.7% in 2021. Private health insurance coverage was more prevalent than public coverage, with 65.6% of people having private insurance and 36.1% having public coverage. Employment-based insurance was the most common type of coverage, followed by Medicaid, Medicare, direct-purchase coverage, TRICARE, and VA and CHAMPVA coverage.

The decrease in the number of uninsured people was also observed among working-age adults aged 19 to 64, with a decrease of 0.8 percentage points from 2021 to 2022. This decrease was driven in part by a decline in uninsured rates for workers. Among all Americans, the percentage without health insurance decreased from 10.3% in 2019 to 8.4% in 2022.

The decline in the number of uninsured people in the US during this period was also notable among children, with 4.2% or 3 million children lacking health insurance in 2022 compared to 5.1% or 3.7 million in 2019. Racial and ethnic disparities in coverage persist, with Hispanic adults being more likely to lack insurance than Black, White, and Asian adults. Additionally, adults in non-Medicaid expansion states were twice as likely to be uninsured compared to those in Medicaid expansion states.

The decrease in the number of uninsured people in the US from 2019 to 2022 highlights the impact of policies and expansions aimed at improving access to health insurance coverage. However, it is important to note that despite these gains, millions of people in the US still lack health insurance, and disparities exist across demographic groups.

44 million Americans are uninsured, with 8/10 workers or their dependents

44 Million Americans Without Insurance

In the US, about 44 million people have no health insurance, and another 38 million are inadequately insured. This means that nearly one-third of Americans live without the security of knowing that medical care is available to them and their families if and when they need it.

Why Being Uninsured is a Problem

People without health insurance often postpone necessary care and forego preventive measures such as childhood immunizations and routine check-ups. They usually have no regular doctor and limited access to prescription medications, leading to a higher likelihood of hospitalization for avoidable health conditions.

The Downward Spiral of Avoiding Medical Care

The fear of medical bills leads many uninsured individuals to delay seeking treatment until the last minute. This results in a downward spiral of higher healthcare costs for everyone. More than one-third of uninsured adults face challenges in paying their bills, and when they are unable to pay, the financial burden falls on the insured population, hospitals, doctors, and the government. These billions of dollars in "uncompensated care" drive up health insurance premiums across the board.

Who Are the Uninsured?

Eight out of ten uninsured Americans are workers or their dependents. They are employed but lack the security of health coverage, often due to the high cost of insurance. This situation is particularly prevalent in low-income families, where most uninsured individuals reside.

Racial and Ethnic Disparities

Racial and ethnic disparities persist in health coverage, with people of color comprising a disproportionate share of the uninsured population. Despite overall gains in coverage, non-elderly Hispanic and American Indian/Alaska Native individuals continue to experience higher uninsured rates than their White counterparts.

The Impact of the Affordable Care Act (ACA)

The ACA's coverage expansions, including Medicaid expansion and subsidized Marketplace coverage, served as a safety net for many during the coronavirus pandemic. As a result, the number of non-elderly uninsured individuals decreased from 27.5 million in 2021 to 25.6 million in 2022, with the uninsured rate dropping to a record low of 9.6%. However, with the end of the Medicaid continuous enrollment provision, these gains may be reversed.

In 2021, 8.3% of people in the US had no health insurance

In 2021, 8.3% of people in the US, or 27.2 million, did not have health insurance at any point during the year. This figure represents a decrease in the uninsured rate and number of uninsured people from 2020, when 8.6% of people, or 28.3 million, were without health insurance.

The US government's Affordable Care Act (ACA) has been instrumental in expanding health insurance coverage, especially during the coronavirus pandemic. The ACA's coverage expansions, such as Medicaid expansion and subsidized Marketplace coverage, served as a safety net for those who lost their jobs or faced economic hardships during the pandemic. As a result, the number of uninsured individuals in the US continued a downward trend, dropping from 27.5 million in 2021 to 25.6 million in 2022. The uninsured rate also decreased from 10.2% in 2021 to a record low of 9.6% in 2022.

Despite these improvements, it is important to recognize that most uninsured individuals are from low-income families and often have at least one worker in the family. Racial and ethnic disparities in coverage also persist, with people of color accounting for a disproportionate share of the uninsured population. Additionally, undocumented immigrants are ineligible for federally funded coverage, further contributing to the challenges of ensuring universal health insurance coverage.

The high cost of insurance remains a significant barrier for many uninsured individuals. In 2022, 64% of uninsured nonelderly adults cited the expense of coverage as the primary reason for lacking insurance. The complexity of the US health insurance system, which ties coverage to factors such as employment and income level, also contributes to the challenges of ensuring universal coverage.

The consequences of lacking health insurance can be severe. Uninsured individuals often face unaffordable medical bills and are more likely to delay or forgo necessary medical care due to financial constraints. They are also less likely to receive preventive care and services for major health conditions and chronic diseases, potentially leading to adverse health outcomes and higher mortality rates.

Addressing the issue of uninsured individuals remains a critical priority, and further efforts are needed to ensure that all Americans have access to affordable and comprehensive health insurance coverage.

In 2022, 92.1% of people in the US had health insurance

The US Census Bureau report, "Health Insurance Coverage in the United States: 2022", provides a detailed overview of health insurance coverage in the country. The report found that private health insurance coverage was more prevalent than public coverage, with 65.6% of people having private insurance and 36.1% having public insurance. Employment-based insurance was the most common type of health insurance, covering 54.5% of the population for some or all of the calendar year. This was followed by Medicaid (18.8%), Medicare (18.7%), direct-purchase coverage (9.9%), TRICARE (2.4%), and VA and CHAMPVA coverage (1.0%).

The report also showed a decrease in the uninsured rate among working-age adults aged 19 to 64, with a 0.8% decrease from 2021 to 2022. Additionally, the number of uninsured children also decreased, with 4.2% or 3 million children lacking health insurance in 2022 compared to 5.1% or 3.7 million in 2019.

The findings highlight the impact of the Affordable Care Act (ACA) and pandemic-era policies in expanding health insurance coverage. The continuous enrollment provision in Medicaid and enhanced subsidies in the Marketplace protected low-income individuals and improved the affordability of private coverage. As a result, the number of nonelderly uninsured individuals decreased by nearly 1.9 million from 2021 to 2022, and the uninsured rate dropped to a record low of 9.6%.

While the report shows significant progress in expanding health insurance coverage, it is important to note that disparities still exist. For example, adults aged 19 to 25 years had the highest rate of no insurance for the entire year at 14%, and racial and ethnic disparities in coverage persist. Additionally, the high cost of insurance remains a barrier for many, with 64% of uninsured nonelderly adults citing it as the main reason for lacking coverage.

Uninsured rates decreased in over half of US states in 2022

According to the US Census Bureau, the number of Americans without health insurance decreased in over half of US states in 2022. The share of people without health insurance coverage decreased in 27 states between 2021 and 2022, with 15 of these states experiencing increases in Medicare coverage, eight in Medicaid coverage, and six in VA coverage.

The decrease in uninsured rates was driven by a combination of factors, including changes in the types of health insurance coverage available and the implementation of policies to improve access to insurance during the COVID-19 pandemic. During the pandemic, Congress passed measures to improve access to public and private health insurance coverage, including continuing coverage for people receiving Medicaid and introducing policies to help people access and afford the cost of care. These pandemic-era policies, along with a strong job market, contributed to a decline in uninsured rates across the country.

In 25 states that experienced a decrease in the uninsured rate, there were significant changes in at least one type of public or private insurance. Only Utah and North Dakota saw decreases in uninsured rates without significant changes in the types of coverage offered.

The overall number of Americans without health insurance dropped by 5.6 million from 2019 to 2022. Among working-age Americans (ages 18-64), 12.2% did not have health insurance in 2022, a decrease from 14.7% in 2019. Additionally, the number of nonelderly uninsured individuals continued a downward trend, dropping by nearly 1.9 million from 27.5 million in 2021 to 25.6 million in 2022.

The decrease in uninsured rates in over half of US states in 2022 is a positive development, indicating that more people have access to health care services and financial protection in the event of medical needs.

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