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The Uninsured: A Primer - Key Facts About Health Insurance and the Uninsured in America

Millions of people in the United States go without health insurance each year. Because nearly all of the elderly are insured by Medicare, most uninsured Americans are nonelderly (below age 65). A majority of the nonelderly receive their health insurance as a job benefit, but not everyone has access to or can afford this type of coverage. Together, Medicaid and the Children’s Health Insurance Program (CHIP) fill in gaps in the availability of coverage for millions of low-income people, in particular, children. However, Medicaid eligibility for adults remains limited in some states, and few people can afford to purchase coverage on their own without financial assistance.

The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. The access barriers facing uninsured people mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact also can be severe. Uninsured families struggle financially to meet basic needs, and medical bills can quickly lead to medical debt.

A major goal of the Affordable Care Act (ACA), which was passed in 2010, was to expand coverage to millions of Americans who were previously uninsured. The ACA has filled existing gaps in coverage by providing for an expansion of Medicaid for adults with incomes at or below 138% of poverty in states that chose to expand, building on employer-based coverage, and providing premium tax credits to make private insurance more affordable for many with incomes between 100-400% of poverty.1 Most of the major coverage provisions of the ACA went into effect in 2014, and millions of people have enrolled in coverage under the law.

The Uninsured: A Primer is structured in two parts. The first presents basic information about health coverage and the uninsured population leading up to and after the implementation of the Affordable Care Act, who the uninsured are and why they do not have health coverage. The second presents information on the impact lack of insurance can have on health outcomes and personal finances, and provides an understanding of the difference health insurance makes in people’s lives.

What Was Happening to Insurance Coverage Leading up to the ACA?