In the U.S. health care system, health insurance provides better access to medical care, preventive services, and offers financial protection. Despite historic health insurance enrollment since the COVID-19 pandemic, millions of Americans remain uninsured, particularly adults between the ages of 19 and 64. Understanding the uninsured rate and its variations is essential to grasp the public health and economic implications of this issue. Data from the Kaiser Family Foundation (KFF) reveals a comprehensive view of the uninsured rate across states, demographic groups, and economic factors, allowing us to see where gaps in coverage exist and what challenges remain. 

National Overview of the Uninsured Rate 

According to the KFF, approximately 12.2% of adults aged 19-64 in the U.S. were uninsured as of data from 2023. This national rate reflects slight improvements over the past decade, particularly since the Affordable Care Act (ACA) expanded access to Medicaid and marketplace subsidies. However, despite this progress, the uninsured rate for working-age adults remains high in certain areas and among specific groups, underscoring the need for continued efforts to close these gaps. 

Impact of Medicaid Expansion  

Medicaid expansion under the ACA has played an important role in decreasing uninsured rates in states that have chosen to adopt it. These states generally experience lower uninsured rates because the expansion extends coverage to low-income adults who were previously without options. For instance, Kentucky’s uninsured rate decreased from 20.4% in 2013 to 8.6% after adopting Medicaid expansion, highlighting a notable difference compared to states that have not expanded Medicaid, which tend to have higher uninsured rates.  

State-by-State Analysis 

The uninsured rate varies significantly by state, influenced by policy choices, economic factors, and demographics. According to KFF data, states with the highest uninsured rates include Texas (23.6%), Oklahoma (20.2%) and Florida (19.4%). 

Conversely, states like Massachusetts (3.7%), Hawaii (4.6%), and Vermont (5%) have some of the lowest uninsured rates in the country. These states have implemented robust public health programs, with Massachusetts being a pioneer in health reform even before the ACA, providing a model for state-based health coverage expansion. Medicaid expansion and state-level policy initiatives play a crucial role in these low rates, showing that local decisions can have a significant impact on health care accessibility. 

Demographic Factors Influencing the Uninsured Rate 

The uninsured rate also varies considerably across demographic groups: 

  • Age Groups: Younger adults (ages 19-34) have higher uninsured rates compared to older adults, often due to affordability challenges and competing financial priorities. Being generally healthier, many in this age group are more willing to accept the risk of going without coverage, assuming they won’t need extensive medical care. This combination of cost concerns and perceived low health risk leads many younger adults to forego health insurance altogether. 
  • Income Levels: Low-income individuals are more likely to be uninsured, even with Medicaid availability in some states. Cost remains a significant barrier for people in this category, especially in states without Medicaid expansion. 
  • Race and Ethnicity: KFF data shows disparities in uninsured rates among racial and ethnic groups. Hispanic and Black adults are more likely to be uninsured compared to their white counterparts, reflecting broader systemic inequities in health care access. 
  • Employment Status: Uninsured rates are higher among self-employed individuals, part-time workers, and those employed by small businesses that do not provide health benefits. Full-time employees in larger firms generally have better access to employer-sponsored insurance. 

Consequences of High Uninsured Rates 

High uninsured rates have serious consequences for individuals, health care systems, and the economy: 

  • Health Outcomes: Uninsured individuals often delay or forgo medical care, leading to poorer health outcomes. They are less likely to receive preventive services, which can result in higher rates of chronic disease and more severe health issues when they eventually seek treatment. 
  • Financial Burden: The uninsured rate imposes a financial strain on hospitals and health care providers, who absorb the costs of uncompensated care. This burden can also lead to higher healthcare costs for everyone, as providers shift costs to insured patients to make up for losses. 
  • Social and Economic Costs: High uninsured rates affect workforce productivity and public health, as untreated illnesses can lead to absenteeism and reduced productivity. For communities, these high rates can strain local resources and public health systems, highlighting the broader societal costs of inadequate coverage. 

The uninsured rate remains a significant issue in the U.S., with considerable variations by state and demographic group. Continued efforts to reduce the uninsured rate are essential for improving public health outcomes, reducing financial burdens on healthcare systems, and supporting economic stability. Addressing the ongoing uninsured issue requires collaboration among policymakers, health care providers, and community organizations. With open enrollment for 2025 coverage well underway, we are hoping to see gains in enrollment in states across the country.