The United States has a multi-payer health care system, which broadly means that some people are covered by private insurance, while others receive health care from public insurance programs. However, nearly 31 million Americans lacked health insurance coverage in 2019. Should uninsured individuals require health care, they are likely to face significant financial consequences and often pay a higher proportion of the bill out of pocket. Costs can quickly add up in the United States: the annual expenditure per resident was an estimated 10,586 U.S. dollars in 2018.
Public health insurance in the United States
The first public health insurance programs were signed into U.S. law in 1965. Medicare is solely funded by the federal government and focuses primarily on individuals aged 65 and older. Medicaid is a joint federal and state program that provides medical coverage to several broad enrollment groups. In 1997, the Children’s Health Insurance Program (CHIP) was created to provide insurance to children in families with incomes that were too high to qualify for Medicaid but too low to afford private health insurance. Despite consistent coverage gains, approximately four million children were uninsured in the United States in 2018.
How the Affordable Care Act pushed uninsured rates down
The uninsured rate in the United States stood at 9.5 percent in 2019, but the figure was as high as 16 percent around a decade earlier. In 2010, the introduction of the Affordable Care Act (ACA) helped to address coverage gaps in the health care system. Under the ACA, states now have the option to expand Medicaid to cover nearly all low-income adults under age 65 based on income eligibility thresholds. Previously, most low-income adults without children were not eligible for Medicaid – adults living alone still account for the highest number of non-elderly people without health insurance. States can choose whether or not to expand Medicaid – most have chosen to do so – and they also have the power to include additional groups and benefits in their version of the plan.
Access to affordable private health insurance
Since 2010, the number of uninsured people under age 65 has fallen by around 20 million. In states that have not expanded Medicaid, eligibility for non-elderly adults remains limited, but other insurance options are available. Private health insurance policies are more common, and more than half of the population are receiving employment-based health insurance – further examples of private insurance include plans purchased directly by an individual or through a health insurance marketplace. Not all employers provide health benefits, and in some cases, employees decide against the offer because of the high costs involved. However, actively choosing to go without insurance coverage can have serious health consequences.
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In the following 6 chapters, you will quickly find the 37 most important statistics relating to "Americans without health insurance".