In 2014, 12% of the nonelderly lacked insurance coverage. Over half (56%) received health coverage as a benefit through their own or a family member’s job, 5% purchased coverage on their own through the “non-group” market, and over one in five (22%) were covered by public coverage such as Medicaid or CHIP.

Corresponding with implementation of the Affordable Care Act, the total number of nonelderly uninsured people nationally dropped from 41.1 million in 2013 to 32.3 million in 2014. Nearly the entire decline in the number of uninsured people occurred among adults.

Compared to an uninsured rate of 14% for nonelderly adults, 6% of children were uninsured in 2014. This disparity reflects ongoing differences in eligibility for Medicaid, as well as expanded eligibility for public coverage available to children through the Children’s Health Insurance Program (CHIP). While the ACA has increased Medicaid eligibility levels for adults, they remain below those of children in most states. As of January 2015, the median Medicaid/CHIP income eligibility threshold for children in Medicaid expansion states was 305%, compared to 138% for adults. In non-expansion states, the median was 215% for children, 45% for parents, and childless adults were excluded in all but one non-expansion state.

While undocumented immigrants and “young invincibles” are at increased risk of being uninsured, most of the uninsured—about 85%--are in a family with at least one worker. However, not all employers offer coverage to their employees, and not all employees in firms that provide coverage are eligible. For example, part-time workers may not be eligible for coverage. When offered insurance, most eligible workers choose to take up coverage, though the rising cost of employer-sponsored insurance makes it harder for employees to afford their share of the costs.

Some uninsured individuals experience relatively brief spells without health insurance due to transitions between coverage. However,  over half of uninsured people have been without coverage for over a year and nearly one in five has never had coverage in his/her lifetime.

Over half of uninsured people lived in households with annual income below 200% of the federal poverty level, or $38,110 for a family with two adults and one child in 2014. Though the provisions in the ACA aim to make coverage more affordable, almost half of uninsured adults say that the main reason they lack coverage is because it is too expensive. Few uninsured adults say that they are uninsured because they do not need coverage, oppose the ACA, or would rather pay the penalty.

Having health insurance makes a difference in whether and when people get medical care. Those without insurance are less likely than those with to receive preventive care, which leads them to be diagnosed at later stages of illness. Among those with health needs, uninsured individuals are less likely to be able to follow recommended care for an illness, receive fewer therapeutic services, and have higher mortality rates than the insured. The uninsured are also less likely to report being in excellent or very good health than the general nonelderly population.

Over three million poor adults fell into a coverage gap in the twenty states that had not expanded Medicaid as of 2015. These adults have incomes above Medicaid eligibility limits in their state but below the lower limit for Marketplace premium tax credits, which begin at 100% FPL ($20,090 for a family of three in 2015). Because the ACA envisioned that people below poverty would be eligible for Medicaid, it does not make premium subsidies available to poor people, and Medicaid eligibility for adults in non-expansion states is very low. In non-expansion states, the median income eligibility level for parents is 44% FPL ($8,840 for a family of three in 2015) and 0% for childless adults. People in the coverage gap are concentrated in Southern states, with the largest number of people in the coverage gap in Texas (766,000 people) followed by Florida (567,000), Georgia (305,000), and North Carolina (244,000).