Uninsured (As per America's Health Rankings)

U.S. Value: 9.2% (2020);  8.6% (2021); 8.0% (2022)

Healthiest State: Massachusetts: 3.0% (2020); 2.5% (2021); 2.4% (2022)

Least-healthy State: Texas: 18.4% (2020); 18.0% (2021); 16.6% (2022)

Definition: Percentage of population not covered by private or public health insurance

Data Source & Year(s): U.S. Census Bureau, American Community Survey, 2019; 2020; 2022.

Suggested Citation: America's Health Rankings analysis of U.S. Census Bureau, American Community Survey, United Health Foundation, AmericasHealthRankings.org, accessed 2024.

WHY DOES THIS MATTER?

Health insurance is critical in helping people get the preventive and acute medical care they need to achieve and maintain good health. The nation’s uninsured rate dropped significantly after the Affordable Care Act was enacted, yet over 26.3 million people were still uninsured in 2022. In 2021, an analysis found that 69.6% of uninsured adults reported that they were uninsured because they could not afford health insurance. 

Compared with insured adults, uninsured adults have more health disadvantages, including: 

• Worse health outcomes.
• Higher rates of mortality and premature death.
• Higher rates of cancer mortality and greater risk of late-stage cancer diagnosis. 
• Inadequate access to quality care, including preventive services. 
• Expensive medical bills due to undiagnosed or untreated chronic conditions.
• More complex and expensive emergency room visits. 

One study estimated that adults ages 20 to 64 in three Medicaid expansion states experienced a 6% decline in all-cause mortality compared with adults living in demographically and economically similar states that did not expand Medicaid. This decline was largely from medical conditions that respond well to medical management, such as HIV, heart disease and diabetes.

WHO IS AFFECTED?

Populations with higher uninsured rates include:

• Adults ages 26-34 compared with all other age groups. Older adults ages 55-64 had the lowest rates of being uninsured. 
• American Indian/Alaska Native and Hispanic adults as well as those who identify as other race compared with other racial and ethnic groups. White adults had the lowest rate.
• Adults with less than a high school education compared with those with higher education levels.
• Individuals living in non-Medicaid expansion states compared with those in Medicaid expansion states.
• Individuals with income levels below 100% of the federal poverty level compared with individuals with higher incomes.
• Noncitizen (lawfully present and undocumented immigrants) adults compared with the general U.S. population.

GOALS

A Healthy People 2030 leading health indicator is to increase the proportion of people with health insurance from 89.8% to 92.4%.

https://www.americashealthrankings.org/explore/annual/measure/HealthInsurance/state/IN. Last accessed March 2024.

WHAT WORKS?

The Medicaid expansion decreased uninsured rates among low-income individuals and vulnerable populations in states that expanded Medicaid. Currently, 45% of the uninsured population do not have access to health coverage provided by the Affordable Care Act because they live in a state that has not expanded Medicaid, they are not a U.S. citizen or their income is too high to be eligible for subsidies. Additional states adopting the Medicaid expansion or a policy change to make non-citizens eligible for health coverage under the Affordable Care Act could decrease the number of uninsured individuals. Increasing knowledge of government assistance programs may increase enrollment of eligible individuals. Policy changes can also help address the affordability issue

Increasing the number of people with health insurance is important to improve health outcomes and decrease health care spending. However, a combination of three strategies — expanding health insurance coverage, delivering better preventive and chronic care and focusing on community prevention — is more effective at saving lives and money than implementing any of these strategies alone.

https://www.americashealthrankings.org/explore/annual/measure/HealthInsurance/state/IN.  Last accessed March 2024

Rising health care costs, the economic downturn, an erosion of employer-based insurance, and public program cutbacks. Developing effective strategies for reducing uninsurance requires understanding why people lack insurance coverage. 

• In 2018, uninsured working-age adults in the United States were disproportionately low income, Latino, and under age 35.
• Following the ACA individual market subsidies and reforms, the share of adults who had tried to buy a plan in the individual market and reported difficulties finding an affordable plan fell from 60 percent to 34 percent. In 2018, 42 percent of adults reported difficulty finding affordable coverage. 
• Despite having low income, nearly six in ten people in the coverage gap are in a family with a worker, and over four in ten are working themselves (Figure 6).  Adults who work may still have incomes below poverty because they work low-wage jobs.
• People in the coverage gap are disproportionately people of color. Nationally, over six in ten (62%) people in the coverage gap are people of color, a share that is higher than for non-elderly adults generally in non-expansion states (53%) and for non-elderly adults nationwide (46%) (Figure 5). 

https://www.commonwealthfund.org/publications/issue-briefs/2019/aug/who-are-remaining-uninsured-and-why-do-they-lack-coverage  Last accessed March 2024

https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/ Last accessed March 2024

• If all states adopted the Medicaid expansion, approximately 2.9 million uninsured adults would become newly eligible for Medicaid. This number includes the 1.5 million adults in the coverage gap and an additional 1.4 million uninsured adults with incomes between 100% and 138% FPL, most of whom are currently eligible for Marketplace coverage but not enrolled 
• Two-thirds (67%) of uninsured adults had not gone to the marketplace to examine their coverage options. Of those, one-third (36%) said they didn’t think they could afford health insurance.
• Most of the adults who are currently eligible for coverage in the Marketplace qualify for plans with zero premiums.

https://www.commonwealthfund.org/publications/issue-briefs/2019/aug/who-are-remaining-uninsured-and-why-do-they-lack-coverage   Last accessed March 2024

https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/  Last accessed March 2024

https://www.americashealthrankings.org/explore/measures/HealthInsurance/IN Last accessed March 2024, October 2024