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Americans without health insurance – statistics & facts

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. Meanwhile, in 2021 over 31 million Americans lacked health insurance coverage. Should uninsured individuals require health care, they are likely to face significant financial consequences and need to pay large medical bills out of pocket. Costs can quickly add up leaving them susceptible to medical debt.

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, while Medicaid is a joint federal and state program that provides medical coverage to those of low income. 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, over four million children were uninsured in the United States in 2020.

How the Affordable Care Act pushed uninsured rates down

The uninsured rate in the United States stood at 9.6 percent in 2021, 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 – 12 states have not done so as of November 2021 – and they also have the power to include additional groups and benefits in their version of the plan.

The coverage gap

Since 2010, the share of uninsured adults under age 65 has dropped by half in states that have expanded Medicaid, while the share of uninsured adults dropped just one-fifth in non-expansion states. An estimated 2.2 million people fall under the Medicaid Coverage Gap with a third in Texas alone. The coverage gap refers to those who earn too much to qualify for Medicaid, but too little to afford private health insurance. In Texas for example, as of January 2021 a parent with dependent children (family of three) earning more than 17 percent of FPL (roughly 300 U.S. dollars) per month would not be eligible for Medicaid. At a time of national and international health crisis, more focus should be given to those without any health coverage.


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