OUR WORK
The Persistently Uninsured
Private sector and public health care stakeholders, along with federal and state policymakers, have shaped enrollment policies and improved processes across health plans and programs over the last decade. At the same time, an estimated 25.3 to 25.6 million Americans are not currently enrolled in health coverage. Even before the COVID-19 pandemic, roughly 30 million Americans lacked health coverage at any point in 2019.[1] The uninsured are also disproportionately likely to be Black or Latino.[2]
Some of the effects of a lack of health coverage for a meaningful portion of the population are well established: less access to and use of preventative care, barriers accessing high-quality health care, high out of pocket costs, delays in accessing care, and worse health outcomes, especially for older, less healthy patients.
Millions Eligible For Coverage, But Not Yet Enrolled
Despite these challenges stemming from lack of insurance, research indicates most such individuals are eligible for, but not enrolled in, a current health care plan or program. According to a 2022 analysis by the Congressional Budget Office, “10 percent of the population was without insurance in 2021 and 9 percent will be without insurance in 2022.” Of the individuals uninsured in CBO’s projection, 61 percent were eligible for subsidized coverage.
An updated report by KFF in 2023 found that 60 percent of uninsured individuals are eligible for subsidized coverage, with 25 percent of individuals being eligible for Medicaid and 35 percent of individuals being eligible for Marketplace subsidies.[3] Roughly 6 percent of individuals are uninsured because they fall into the coverage gap in non-expansion Medicaid states. Our one-pager on the eligible uninsured is linked here.
The Urban Institute also conducted research throughout 2022 that sought to identify barriers to coverage for uninsured individuals. 22.2 percent of uninsured adults said signing up was too difficult, however the most cited barrier to coverage by uninsured individuals continues to be the lack of affordability of health insurance. In 2022, 64.2 percent of uninsured nonelderly adults said they were uninsured because coverage is not affordable.[4] The Enrollment Coalition published a one-pager in May 2024 that further details the barriers to coverage that uninsured individuals face.
A Fresh Urgency
The Medicaid redetermination period has placed a renewed sense of urgency and focus on helping Americans find and enroll in health coverage for which they are eligible.
The COVID-19 pandemic has also focused needed attention on longstanding challenges millions of Americans face in health care –whether due to racial inequities, health disparities, socio-economic differences, or social determinants of health. Thus, coverage efforts also need to acknowledge and help address the real hurdles and challenges many face to receiving equitable access and care. New policies, strategies and tools to improve enrollment must be informed by and appropriately take into account these dynamics.
[1] Congressional Budget Office, Who Went Without Health Insurance in 2019, and Why? September 2020, https://www.cbo.gov/publication/56658.
[2] ASPE Issue Brief: TRENDS IN THE U.S. UNINSURED POPULATION, 2010-2020, February 11, 2021, https://aspe.hhs.gov/system/files/pdf/265041/trends-in-the-us-uninsured.pdf.
[3] Kaiser Family Foundation: Key Facts about the Uninsured Population https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
[4] The Urban Institute: Guide to Equity for the Uninsured https://www.urban.org/sites/default/files/2024-01/Guide%20to%20Equity%20for%20the%20Uninsured.pdf