Discover the Shocking Truth About the Uninsured Population and Health Care Coverage: What You Need to Know!
In 2022, there were 25.6 million uninsured nonelderly persons, and the uninsured rate among the nonelderly population was 9.6%, the lowest in U.S. history (Figure 2). The analysis of the uninsured population focuses on coverage of the nonelderly because the Medicare program provides nearly universal coverage for the elderly: only 457,000, or less than 1 percent, of people over age 65 are uninsured.
Prior to the ACA, gaps in public insurance and lack of access to affordable private insurance left more than 40 million people without health insurance. The ACA expanded health insurance coverage by extending Medicaid to nearly all adults with incomes up to 138% of the federal poverty level (FPL) (the poverty level in the continental U.S. is $14,580 for a single person in 2024) and creating new health insurance Marketplaces through which people can purchase insurance with financial assistance to afford premiums and cost-sharing. Since the passage of the ACA in 2010 and the implementation of coverage provisions, the number of uninsured nonelderly people has fallen to 27 million in 2016. The ACA provided that all states would accept Medicaid expansion, but a Supreme Court ruling in 2012 made program expansion optional for states. As of early 2024, 40 states and Washington, D.C., have adopted Medicaid expansion under the ACA (Figure 3).
The decline in uninsured rates after implementation of the ACA coverage expansions was greatest among poor and near-poor nonelderly individuals, especially adults. People of color, who had higher rates of uninsurance than whites before 2014, experienced larger gains in coverage than whites between 2013 and 2016, although coverage disparities were not eliminated.
Prior to the implementation of the ACA, the expansion of Medicaid coverage and the introduction of the Children's Health Insurance Program (CHIP) helped reduce the rate of uninsured children. Changes in the 1980s and early 1990s expanded Medicaid eligibility for children and pregnant women, and the creation of CHIP in 1997 provided coverage for children with incomes above Medicaid thresholds. When states implemented CHIP, extensive outreach and the adoption of simplified procedures helped attract children to Medicaid and CHIP and reduce the number of uninsured children.
After declining in 2016, the number of uninsured individuals and the uninsured rate began to rise in 2017 and continued to rise through 2019. Generally favorable economic conditions, as well as policy changes in the Trump administration, such as reducing funding for outreach and enrollment assistance, encouraging periodic Medicaid eligibility verification, changes in immigration policy related to state payment rules, and approval of certain demonstration waivers to limit enrollment, resulted in a decline in Medicaid enrollment, which likely contributed to the increase in the number of uninsured.