why are people uninsuredwhy are people uninsured

Report: Those With Limited English Proficiency Are More Likely to be The Affordable Care Act in Depth | RAND Concern about the cost of insurance is a key reason why many are uninsured. Interactive Teaching Tools, Without Reform, Social Security Could Become Depleted Within the Next Decade. Some uninsured who are eligible for help may not be aware of coverage options or may face barriers to enrollment, and even with enhanced subsidies, Marketplace coverage may be unaffordable for some uninsured individuals. 13. But when IndyMac failed, also in 2008, uninsured account holders recovered 50 percent of uninsured deposits. In addition, people of color made up 45.1% of the nonelderly U.S. population but accounted for 61.3% of the total nonelderly uninsured population. 2023 Peter G. Peterson Foundation. Public hospitals, community clinics and health centers, and local providers that serve underserved communities provide a crucial health care safety net for uninsured people. There are many possible reasons for that increase in healthcare prices: The introduction of new, innovative healthcare technology can lead to better, more expensive procedures and products. Share on Facebook. Why are people uninsured? Despite coverage gains during the pandemic, 27.5 million nonelderly people remained uninsured in 2021, many of who were eligible for assistance via the Marketplace, Medicaid, or CHIP but not enrolled in these programs. A lock ( At the same time, likely due to pandemic-related disruptions to employment, the share of people with employer-sponsored insurance dropped from 58.1% in 2019 to 57.0% in 2021 (Figure 2). The uninsured rate in 2021 declined to 10.2% from 10.9% in 2019, and the number of people who were uninsured in 2021 decreased by 1.5 million from 2019 to 2021 (Figure 1). As part of the ACA, 32 states and the District of Columbia expanded Medicaid eligibility before January 2019. Collins and Tikkanen, Many Varieties of Universal Coverage, 2019. 21. Sara R. Collins, Sherry A. Glied, and Adlan Jackson, The Potential Implications of Work Requirements for the Insurance Coverage of Medicaid Beneficiaries: The Case of Kentucky (Commonwealth Fund, Oct. 2018). The uninsured rate among children under the age of 19 decreased 0.6 percentage points to 5.0 percent between 2020 and 2021, driven in part by an increase in public coverage. One of the main reasons why adults say they are uninsured is because of the cost of insurance being too high. , leaving individuals living in rural areas at an even greater disadvantage to accessing care. 16. The law aims to extend health coverage to uninsured Americans, estimated at the time the bill was passed to number around 47 million. Well, perhaps not directly. Jennifer Tolbert , Both Medicaid and CHIP provide health insurance coverage for vulnerable populations, including children. The previous surveys were conducted by Princeton Survey Research Associates International using the same stratified sampling strategy that was used in 2018, except the 2001, 2003, and 2005 surveys did not include a cellular phone random-digit-dial sample. In 2018, 27.5 million people - more than 8% of the U.S. population - were uninsured, according to the U.S. Census Bureau. Even so, IndyMac was the costliest failure in the FDIC's history - a $12.4 billion . However, safety net providers have limited resources and service capacity, and not all uninsured people have geographic access to a safety net provider. About two-thirds of uninsured people were eligible for some form of subsidized coverage, although the generosity of available subsidies varied on the basis of peoples family income, access to employment-based coverage, and other factors. Of those with health insurance in 2021, 216 million people were enrolled in a private program and 117 million in a public program. In 2018 there were 18.2 million fewer uninsured people in the U.S. than when the ACA became law.1 In addition, fewer people are forgoing health care because of cost or reporting high out-of-pocket costs relative to their income.2. Coverage gains were greater for nonelderly adults compared to children. So who were the uninsured? Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy they are. Study looks to show why people are uninsured - Yahoo Non-citizens are more likely than citizens to be uninsured. Radley, Collins, and Hayes, 2019 Scorecard, 2019. How have health insurance coverage options and availability changed under the ACA. 26. More children under the age of 19 in poverty were uninsured in 2020 than in 2018. Prior to the enactment of the ACA in 2010, people of color were at much higher risk of being uninsured compared to White people, with . Over two-thirds (73.9%) of the nonelderly adults uninsured in 2021 have been without coverage for more than a year. A .gov website belongs to an official government organization in the United States. But in 2018, these groups remained disproportionately uninsured. The survey also suggests a lack of knowledge among uninsured adults about their coverage options. Uninsured | KFF Harris Health's $2.9B building plan to enhance healthcare for uninsured In fact, most uninsured people (84.6 percent) were 19- to 64-year-olds. Nineteen states have chosen not to expand eligibility, although several of these are considering doing so. These adults would only be eligible for their states existing Medicaid program, which is usually only available to children and very poor parents, or unsubsidized plans in the marketplaces. The remainder of uninsured adults would not qualify for either: 11 percent earn below 100 percent of poverty and live in a state that did not expand Medicaid;5 8 percent have incomes at or above 400 percent of poverty and are ineligible for the tax credits; and 25 percent were foreign-born Latinos and may be ineligible for Medicaid or subsidized plans because of their immigration status. Anthony Damico Share on Facebook. Uninsured people who are eligible for Medicaid have more financial protection than others because they can enroll without waiting for an open enrollment periodin some cases, as they are seeking care in hospitals or other settingsand may receive coverage retroactively. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 While federal law requires nonprofit hospitals to provide some level of charity care as a condition of receiving tax-exempt status, and many state governments impose additional requirements on hospitals to extend eligibility for charity care, not all eligible patients benefit from these programs because they do not know about the programs, do not know how to apply, have their application improperly denied, or choose not to apply. One of the reasons why people are signing up is the individual mandate. Research has found that nearly half of foreign-born Latinos are undocumented immigrants. Four percent of adults ages 19 to 64 who were uninsured at the time of the survey or uninsured in the past 12 months and were previously covered by a plan bought on their own or through the marketplace reported they lost or dropped their marketplace coverage because they couldnt get the health care they needed, 2% reported it was because they didnt think they needed it, and 1% reported it was because they moved. Furthermore, nearly one-third (32.2%) of uninsured children had not seen a doctor in the past year compared to 8.1% and 8.0% for children with public and private coverage, respectively (Figure 9). In the first half of 2020, 43.4 percent of U.S. adults ages 19 to 64 were inadequately insured. In 2021, 40.0 percent of the population were people of color, but they accounted for 62.8 percent of the uninsured population. The large sample size of the American Community Survey allows us to take a detailed look at the characteristics of populations, such as the . Medicaid eligibility varies across states and eligibility for adults is limited in states that have not expanded Medicaid. One in five (20%) uninsured adults say that they went without needed care in the past . Many people who were uninsured were eligible for financial assistance either through Medicaid or through subsidized Marketplace coverage. The continued availability of the enhanced Marketplace subsidies will make that coverage more affordable for people who are disenrolled from Medicaid and may increase the share of people who successfully transition from Medicaid to Marketplace coverage. One-third of adults with a coverage gap who were previously insured through the individual market dropped their plans because they could not afford them. (See Appendix Table B for detailed data on characteristics of the uninsured population.). ': As US Bumps Against Debt Ceiling, Medicare Becomes a Bargaining Chip. In 2018, 58 percent of uninsured adults had incomes below 200 percent of the federal poverty level ($24,120 for an individual and $49,200 for a family of four). Because uninsured patients are also less likely to receive necessary follow-up screenings than their insured counterparts,8 they have an increased risk of being diagnosed at later stages of diseases, including cancer, and have higher mortality rates than those with insurance.9,10,11 In addition, when uninsured people are hospitalized, they receive fewer diagnostic and therapeutic services and also have higher mortality rates than those with insurance.12,13,14,15, Uninsured children also face problems getting needed care. Assessing the Effectiveness of State-Based Reinsurance: Case Studies of Three States Efforts to Bolster Their Individual Markets, Consumers Shopping for Health Plans Are Left in the Dark by Trump Administration, Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Answers to the survey questions can help federal and state policymakers find solutions to help uninsured Americans gain coverage. Being underinsured can cause people to go without medical care or lead to debt. Studies repeatedly demonstrate that uninsured individuals are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases. Why does Arizona still have so many without health insurance? When asked why, more than one-third (36%) reported it was because they did not think they could afford it, 15 percent said they did not think they needed it, 8 percent said they did not think they would be eligible for insurance, and 7 percent said they were not aware of the marketplace.6. What are the Different Measures Used? The ACAs subsidies and reforms to the individual market, such as banning preexisting condition exclusions and premium setting based on health and gender, went into effect in 2014. It has been found that health insurance is not owned by around 44 million adults in the US, while 38 million do not have adequate health coverage. Texas Already Had The Most Uninsured. The Pandemic Made It Worse - NPR CBOs analysis sheds light on groups that were not covered by comprehensive health insurance even during the strong economy and historically low unemployment that preceded the 2020 coronavirus pandemic. But in 2018, this progress eroded somewhat: 42 percent of adults reported difficulty finding affordable coverage. What are the financial implications of lacking insurance? FastStats - Health Insurance Coverage - Centers for Disease Control and The disenrollment rate ranges from 76% in Idaho to 10% in Michigan. All Rights Reserved. The number of uninsured individuals remains well below levels prior to enactment of the ACA. Tips for Navigating Medical Care Without Health Insurance | U.S. News In 2017, the number of people without health insurance increased to 28.0 million, up from 27.3 million the year before, according to the latest American Community Survey data released today. 7. https://doi.org/10.26099/h0xy-az24, Delivery System Reform, Health Equity, Uninsured, Health Reform, Affordable Care Act, Coverage and Access, Insurance Access, Private Insurance, Biennial Health Insurance Survey, 2023 The Commonwealth Fund. Stand on Insurance Coverage? People who did not complete high school made up a much larger part of the uninsured population (26.9 percent) than the overall population (11.8 percent). All rights reserved. The adult uninsured rate was 12.5 percent. Though financial assistance is available to many of the remaining uninsured under the ACA, not everyone who is uninsured is eligible for free or subsidized coverage. , fear and confusion may persist. Commonwealth Fund, What Is Your State Doing to Affect Access to Adequate Health Insurance?, interactive map, updated Aug. 22, 2019. Among less than full-time, year-round workers, the . . Uninsured people receive some types of health care and are often not required to pay the full billed charges for that care, but they have substantially less access to care and financial protection than insured people. The ACA excludes undocumented immigrants from both the marketplace subsidies and the Medicaid expansion: they may only buy coverage through the individual market outside the marketplaces. The uninsured population was also disproportionately more likely to live in poverty. In the same time period, enrollment in Medicare increased by about 2.5 million individuals, climbing to 60 million in 2021; that change was partly the result of growth in the number of people age 65 and over. Who remains uninsured after the ACA and why do they lack coverage? Since the health care reform law went into effect, the share of the U.S. population under age 65 without health insurance has fallen to an historic low of 11.9 percent. According to a publication from the Kaiser Family Foundation (KFF) in November 2020, the number of uninsured, nonelderly Americans increased for three straight years, beginning in 2017. The percentage of adults who were currently uninsured because coverage was not needed or wanted decreased with age, from 24.0% among those aged 18-29 to 17.5% among those aged 50-64. Opens in a new window. How does lack of insurance affect access to care? How does deposit insurance work? | Brookings We illustrate that uninsured leverage (i.e., Uninsured Debt/Assets) is the key to understanding whether these losses would lead to some banks in the U.S. becoming insolvent-- unlike insured depositors, uninsured depositors stand to lose a part of their deposits if the bank fails, potentially giving them incentives to run. How Many Uninsured People Are in the ACA Coverage Gap? Medicaid covers many low-income individuals; however, Medicaid eligibility for adults remains limited in some states that have not adopted the ACA expansion. 6 min read Nov. 25According to initial findings from an ongoing study by. 1 (Jan. 2009): 17. In this report, CBO describes that uninsured population. Since 2010 . Changes in the number of uninsured individuals varied across states in 2021. Are You Legally Required to Have Health Insurance | eHealth Timothy S. Jost, Fixing Our Most Pressing Health Insurance Problems: A Bipartisan Path Forward, To the Point (blog), Commonwealth Fund, July 13, 2017. Two-thirds (67%) of uninsured adults had not gone to the marketplace to examine their coverage options. More than three quarters (75.2%) of uninsured nonelderly adults say they are very or somewhat worried about paying medical bills if they get sick or have an accident, compared to 45.9% of adults with Medicaid/other public insurance and 44.3% of privately insured adults (Figure 10). Those without insurance for an entire calendar year pay for over 40% of their care out-of-pocket. A combination of landline and cellular phone random-digit-dial (RDD) samples was used to reach people. Medical bills can put great strain on the uninsured and threaten their financial well-being. Yet about 24 million people still lack coverage. As a result, after increasing for three straight years from 2017 to 2019, the number of nonelderly uninsured individuals dropped by nearly 1.5 million from 28.9 million in 2019 to 27.5 million in 2021, and the uninsured rate decreased from 10.9% in 2019 to 10.2% in 2021. While the national debate about health care is focused on more sweeping reforms, such as Medicare for All, federal and state policymakers have several options to help millions of people keep or gain coverage within the existing law. The uninsured rates for Hispanic people (19.0%) and American Indians and Alaska Natives (21.2%) are more than 2.5 times the uninsured rates for White people (7.2%) (Figure 5). In 2021, 27.5 million nonelderly individuals were uninsured, a drop of nearly 1.5 million from 2019. Anthony Damico Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy they are. Similarly, a higher proportion of working-age adults were uninsured in states that did not expand Medicaid. Health Coverage Affordability Crisis 2020 Biennial Survey Coverage gains were larger among nonelderly Hispanic and Asian people compared to their White counterparts and among low-income individuals and those in working families versus those at higher incomes and those without a worker in the family. Published: Jan 25, 2019. To examine why so many people remain uninsured, we use data from the 2018 Commonwealth Fund Biennial Health Insurance Survey. total premiums for family coverage increased, review of research on the effects of the ACA Medicaid expansion, The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020, Summary: Key Facts about the Uninsured Population. The end of the COVID-19 PHE could reverse these recent coverage gains. Is our healthcare system broken? - Harvard Health Nearly half of uninsured adults may have been eligible for subsidized insurance through the marketplace or their states expanded Medicaid program. Edward Berchick is a demographer in the U.S. Census Bureaus Social, Economic, and Housing Statistics Division. In 2021, nonelderly uninsured adults were more than twice as likely as those with private insurance to have problems paying medical bills (20.3% vs. 8.7%; Figure 10). Underinsurance is the state of an individual having some form of health insurance that does not offer complete financial protection. While outcomes varied by state, those policy changes contributed to a 3.0-percentage-point decrease in the share of uninsured people nationally in the initial year. For children under the age of 19, the uninsured rate decreased from 5.5 percent in 2018 to 5.0 percent in 2021. In 2018, 42 percent of adults reported difficulty finding affordable coverage. As a result, the share of people covered by Medicaid increased by 1.5 percentage points, from 21.0% in 2019 to 22.5% in 2021 and the share of people with non-group coverage increased from 6.9% in 2019 to 7.3% in 2021. 15. Uninsured Americans Stats and Facts 2021 | Policy Advice 2. Read the report to see how your state ranks. NEWPORT NEWS, Va. (WAVY) - A major free health clinic targeting the underserved and uninsured population is coming to the Peninsula this weekend. All Rights Reserved. Recent funding increases for Navigators and other efforts to increase outreach and the availability of enrollment assistance can help people complete the Medicaid renewal process, and if found no longer eligible, transition to other coverage. So who were the uninsured? They tended to be 19 to 64 years old, male, have less than a high school education and/or have lower incomes. The two largest groups in that age range are 26- to 34-year-olds and 35- to 44-year-olds. In addition, nearly all other hospitals and some private physicians provide some charity care. Before these reforms, in 2010, 60 percent of adults who had individual coverage or had tried to buy it in the past three years said it was very difficult or impossible to find affordable coverage. 9. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, MarchJune 2017, Fixing Our Most Pressing Health Insurance Problems: A Bipartisan Path Forward, Marketplace Subsidies: Changing The Family Glitch Reduces Family Health Spending But Increases Government Costs, More Than 10 Million Uninsured Could Obtain Marketplace Coverage Through Special Enrollment Periods, The Potential Implications of Work Requirements for the Insurance Coverage of Medicaid Beneficiaries: The Case of Kentucky, Loss of Health Insurance Among Non-Elderly Adults in Medicaid, 2023 Scorecard on State Health System Performance, U.S. Supreme Court Preserves Medicaid Beneficiaries Rights, Medicaid Work Requirements Wouldnt Increase Employment and Could Imperil Future Labor Market Participation. Significantly more adults with Medicaid gave their coverage high ratings in 2018 compared to 2010. Administrative data point to larger gains in Medicaid coverage than are estimated by the ACS. Stand on Insurance Coverage? But thats not all the figure below tells us. An official website of the United States government. The independent source for health policy research, polling, and news. With plant closings, business layoffs, downsizing, ect, people who had depended on receiving benefits from their jobs now have nothingshow more content Census data show that there were more people insured in 2021 than 2018 an increase of 4.7 million people. See Commonwealth Fund, Status of Medicaid Expansion and Work Requirement Waivers, interactive map, updated July 31, 2019; Rachel Garfield, Kendal Orgera, and Anthony Damico, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid (Henry J. Kaiser Family Foundation, June 2018 and May 2019); and Matthew Buettgens, The Implications of Medicaid Expansion in the Remaining States (Urban Institute, May 2018). The authors thank Robyn Rapoport, Rob Manley, and Erin Czyzewicz of SSRS, and David Blumenthal, Elizabeth Fowler, Chris Hollander, Deborah Lorber, Paul Frame, Jen Wilson, Gabriella Aboulafia, Corinne Lewis, and Roosa Tikkanen of the Commonwealth Fund.