Uninsured: Millions Exposed

In 2022, the number of people without health insurance in the US was at a record low, with 25.6 million uninsured nonelderly individuals, making up 7.9% of the population. This number has been on a downward trend since the enactment of the Affordable Care Act (ACA) in 2010, which expanded Medicaid and established health insurance marketplaces. The drop in uninsured Americans can be attributed to the improved subsidies and federal relief bills that lowered premiums and out-of-pocket costs for those purchasing plans through the ACA's private health insurance markets.

The number of uninsured people in the US in 2022 was 25.6 million

The high cost of insurance was the main reason cited by uninsured nonelderly adults for lacking coverage. In 2022, 64% of this demographic stated that they were uninsured because they could not afford the cost of coverage. This issue disproportionately affects low-income families, with 80.8% of the uninsured population in 2022 having incomes below 400% FPL and nearly half (46.6%) having incomes below 200% FPL.

Racial and ethnic disparities in coverage also persist, with people of colour comprising 45.7% of the nonelderly US population but accounting for 62.3% of the total nonelderly uninsured population. Hispanic and White people made up the largest shares of the nonelderly uninsured population at 40.0% and 37.7%, respectively.

Uninsurance rates also vary by state and region, with individuals living in non-expansion states, where Medicaid eligibility is more limited, being more likely to be uninsured. Two-thirds of nonelderly people who were uninsured in 2022 had been without coverage for more than a year, indicating the need for targeted outreach and enrollment efforts to reach this population.

While the number of uninsured people in the US has decreased, it is important to note that even with insurance, individuals may still face barriers to accessing affordable healthcare. Out-of-pocket costs, high premiums, and limited coverage options can deter people from seeking necessary medical care, highlighting the ongoing need for policy interventions to improve healthcare accessibility and affordability.

The uninsured rate in 2022 was 7.9%

In 2022, 26 million people, or 7.9% of the population, were without health insurance, according to a 2023 report from the Census Bureau. This figure represents a notable portion of the population, yet the uninsured rate in 2022 was the lowest since 2017. The report offers insights into how Americans obtain health coverage, how coverage varies across demographics and age groups, historical changes, and the role of federal programs like Medicare and Medicaid.

The uninsured rate in 2022 was influenced by various factors, including the COVID-19 pandemic and related policies. The pandemic-era coverage expansions implemented under the Affordable Care Act (ACA) served as a safety net for those who lost jobs or faced economic hardships. These expansions included continuous enrollment for Medicaid enrollees and enhanced Marketplace subsidies, protecting low-income individuals from coverage losses and improving the affordability of private coverage. As a result, the number of nonelderly uninsured individuals decreased by nearly 1.9 million from 2021 to 2022, contributing to the overall decline in the uninsured rate.

The uninsured rate also varied across different population segments. For instance, nonelderly adults were more likely to be uninsured than children, with an uninsured rate of 11.3% for adults compared to 5.1% for children. This disparity is largely due to the broader availability of Medicaid and Children's Health Insurance Program (CHIP) coverage for children. Additionally, racial and ethnic disparities persisted, with non-white Americans having higher uninsured rates. People of color comprised 45.7% of the nonelderly US population but accounted for 62.3% of the total nonelderly uninsured population.

Furthermore, the uninsured rate was influenced by state-level factors, such as the expansion of Medicaid eligibility. States that expanded Medicaid eligibility generally had lower uninsured rates compared to states that did not. In 2022, the average uninsured rate for children in states that expanded eligibility was 4.1%, while non-expansion states had an average uninsured rate of 8.1%. Similarly, a higher proportion of working-age adults were uninsured in states without expanded Medicaid coverage.

While the uninsured rate in 2022 decreased to a record low, it's important to recognize that millions of people still lacked health insurance. Addressing this issue remains a critical challenge for policymakers, who must strive to improve the efficiency, accessibility, and affordability of the US healthcare system.

In 2020, 8.6% of people in the US had no health insurance

In 2020, 8.6% of people in the US, or 28 million individuals, had no health insurance at any point during the year. This figure represents a decrease from 2019, when 10.2% of the population, or 27.5 million people, were uninsured. The downward trend in the number of uninsured people continued into 2022, with the uninsured rate reaching a record low of 7.9% or 26 million people. This decrease can be attributed to the implementation of the Affordable Care Act (ACA) in 2010, which enabled states to expand Medicaid eligibility and establish health insurance marketplaces.

The COVID-19 pandemic also played a role in reducing the number of uninsured individuals. Policies implemented during this period, such as the Families First Coronavirus Response Act, increased enrollment in public health insurance programs by requiring states to ensure continuous enrollment. As a result, enrollment in Medicaid and the Children's Health Insurance Program (CHIP) grew by 29.8% from February 2020 to December 2022.

Despite these improvements, certain demographics continue to face higher uninsured rates. For example, in 2022, non-white Americans had the highest rates of being uninsured, with people of color accounting for 58.3% of the uninsured population, despite only making up 41.6% of the total population. Additionally, in 2020, more children under the age of 19 in poverty were uninsured compared to 2018, with uninsured rates for this demographic rising by 1.6 percentage points to 9.3%.

The high cost of insurance is a significant factor contributing to the lack of coverage for many individuals. Even with improvements in affordability due to policy changes, some people still find the cost of insurance too high. Furthermore, undocumented immigrants face additional challenges as they are ineligible for federally funded coverage, including Medicaid and Marketplace plans.

The lack of health insurance has significant implications for access to healthcare and financial stability. Uninsured individuals are less likely to receive preventive care and services for major health conditions, often facing unaffordable medical bills and accumulating medical debt. They are also more likely to delay or forgo care due to costs, potentially leading to adverse health outcomes.

The number of uninsured Americans dropped to an all-time low of 8% in 2022

In 2022, the number of uninsured Americans dropped to an all-time low of 8%—a dramatic decrease from 2010 when the rate was 15%. This equates to 26 million people, or 7.9% of the population, being uninsured, according to a 2023 report from the Census Bureau. The uninsured rate among adults aged 18-64 was 11.8%, while the rate for children aged 0-17 was 3.7%.

The decrease in the number of uninsured Americans is largely due to the implementation of the Affordable Care Act (ACA) in 2010, which enabled states to expand Medicaid eligibility and establish health insurance marketplaces. As a result, the uninsured rate fell below 10% and has remained there since. The continuous enrollment provision in Medicaid and enhanced Marketplace subsidies also played a significant role in reducing the number of uninsured Americans. These policies were put in place during the coronavirus pandemic to protect people who lost their jobs or faced other economic hardships.

Despite these improvements, racial and ethnic disparities in coverage persist. In 2022, people of colour accounted for 58.3% of the uninsured population, although they only make up 41.6% of the total population. Additionally, noncitizens are more likely to be uninsured than citizens, with an uninsured rate of 30.3% for recent immigrants and 33.1% for those who have been in the US for more than five years.

The high cost of insurance is also a significant factor in the number of uninsured Americans. In 2022, 64% of uninsured nonelderly adults cited the cost of coverage as the main reason for lacking insurance. This is particularly true for those in low-income families, who make up the majority of the uninsured population.

The uninsured rate among children in 2022 was 5.1%

In 2022, the uninsured rate among children was 5.1%. This means that nearly 4 million children under the age of 19 lacked insurance coverage. This figure has decreased since 2020, when 475,000 more children were without insurance, and since 2021, when the rate was 5.0%. The decrease in the uninsured rate between 2020 and 2021 was driven by an increase in public coverage, such as Medicaid and the Children's Health Insurance Program (CHIP).

Medicaid provides health insurance coverage for children and adults with incomes below a certain threshold. CHIP provides health insurance for children in families who earn too much to qualify for Medicaid but are unlikely to be able to afford private health insurance. In 2021, 35.9% of children were covered by Medicaid or CHIP, a 1.2% increase from 2020.

The uninsured rate among children varies across states, largely depending on whether a state has expanded Medicaid eligibility. In 2022, the average uninsured rate for children in states that expanded eligibility was 4.1%, while in states that did not, the average rate was 8.1%. In 2021, 36 states and the District of Columbia had expanded Medicaid eligibility, while the remaining 14 states had not.

The number of uninsured children also differs depending on race. In 2022, the rate of uninsured American Indian and Alaska Native children was 11%, while the rate for Latino children was 8%. Black children had an uninsured rate of 4%, and the rate for White and Asian and Pacific Islander children was 4% and 6% respectively.

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