Uninsured/Underinsured

An estimated 100 million Americans were uninsured (28 million) or underinsured prior to the Covid pandemic and the passage of the American Rescue Plan of 2021 (ARP).

Demographics of the Uninsured

As of 2019 there were an estimated 28.9 million uninsured people in the United States, of which 3.9 million were undocumented immigrants.  The remaining 25 million uninsureds fall into three major categories based on potential source of premium support:

  • 11 million eligible for ACA premium subsidies[1], including 1.4 million by virtue of the American Rescue Plan Act of 2021. 
  • 1.1 million eligible for unsubsidized marketplace health plans.
  • 9.5 million are potentially Medicaid eligible, including 1.1 million caught in the eligibility gap in non-expansion states.
  • 3.5 million have offers of affordable coverage from their employers

While almost 80 percent of uninsureds have incomes that exceed the Federal Poverty Level (FPL), approximately one third would be eligible for Medicaid if the ACA eligibility criteria were extended to all 50 states. 

Affordability no Longer the Major Barrier

While it is commonly acknowledged that affordability has been a major contributing factor, the provisions of the recently passed American Rescue Plan of 2021 (ARP) has addressed the affordability problem for most Americans.  Yet estimates of the reduction in uninsureds range from 2.5 to 4.2 million. 

A recent Kaiser Foundation study reports that 10.7 million people are still not eligible for coverage, including 2.2 million in the Medicaid coverage gap in 12 non-expansion states.  But those non-expansion states account for just half of all uninsured Medicaid eligibles.  Further improvements in health plan affordability will have little or no effect on the remaining uninsured; those savings would accrue to state and federal governments.  To further reduce the number of uninsureds, changes to the Medicaid eligibility rules and improvements in enrollment performance will be required.  The remainder of this report addresses possible solutions.

[1] How the American Rescue Plan Act Affects Subsidies for Marketplace Shoppers and People Who Are Uninsured (KFF 3/25/2021)