Uninsured

VI. Key Issues: Financing & Delivery >> D. Health Insurance Coverage >> Uninsured (last updated 4.25.17)

Key Questions

What is the Number of Uninsured?

  • According to the March 2013 CPS, there were 41.953 million uninsured (13.4% of total population) [Table 2].
  • The number of non-elderly who experienced at least one month of being uninsured over a 2-year period (2004-2005) was 82.0 million (31.8%); those who remained uninsured for that entire period numbered 26.1 million (10.1%), while the number uninsured for 4 consecutive years (2002-05) was 17.4 million (6.8%) [Rhoades and Cohen].
  • Uninsured trends. According to the CPS, the overall risk of being uninsured rose from 12.9% in 1987 to 15.4% in 2008, with the highest recorded rate (15.8%) occurring in 1998 and 2006 [DeNavas-Walt: Table C-1].
    Because the survey methodology has changed, it is not possible to compare the latest CPS estimates for 2013 and 2014 to prior years. From a constructed time-series based on the National Health Interview Survey, the uninsured rate has declined from a high of 24.3% in 1963 to 11.3% in the second quarter of 2014 (see Table on p. 11).
  • Institute of Medicine. America’s Uninsured Crisis: Consequences for Health and Health Care (2009).  This report includes an updated review of the research evidence on the dynamics driving downward trends in health insurance coverage.
  • SHADAC. Comparing Federal Government Surveys that Count the Uninsured. September 2012. This brief presents trends in national estimates of uninsurance from four federal surveys, presents the most recent available state-level estimates from these surveys, and describes the main reasons for variation in the estimates across the different surveys.

Who Are the Uninsured?

  • Age. According to the CPS, the risk of being uninsured is highest among young adults (22.6% for 19-25; 23.5% for 26-34) and lowest among the elderly (1.6%) and children under 18 (7.3%) [Table 2].
  • Race/Ethnicity.  According to the CPS, the risk of being uninsured is highest among Hispanics of any race (24.3%) and lowest among non-Hispanic Whites (9.8%), with Blacks (15.9%) falling in between [Table 5].
  • Geographic Location.
    • State Estimates. The Current Population Survey annually reports in the fall estimates of the uninsured by state based on the Annual Social and Economic Supplement (ASEC) to the CPS conducted in March.
    • Model-based Small Area Health Insurance Estimates (SAHIE) for Counties and States. The Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program produces estimates of health insurance coverage for states and all counties. In July 2005, SAHIE released the first nation-wide set of county-level estimates on the number of people without health insurance coverage for all ages and those under 18 years old. In July 2010, SAHIE released 2007 estimates of health insurance coverage by age, sex, race, Hispanic origin, and income categories at the state-level and by age, sex, and income categories at the county-level. The latest figures are for 2012. A look-up table allows users to retrieve data down to the county level by age (under 19, 18-64, 40-64, 50-64 and under 65), sex, race (White alone, not Hispanic; Black alone, not Hispanic; Hispanic (any race), and income (under 138%, <200%, <250%, <400%, 138-400%).
  • Citizenship. In 2013, 8.3 million (or 19.8 percent) of the 41.9 million uninsured were non-citizens and another 3.0 million (or 7.1 percent) were naturalized citizens [Table 5].
  • Income. In 2013, low income was a risk factor for being uninsured; 21.6 percent of the uninsured had an annual household income less than $25,000. However, a similar number of the uninsured (21.3 percent) had annual household incomes of $75,000 or more. [Table 4].

What Access Barriers Are Faced by the Uninsured?

  • Relative to the uninsured, insured Americans are more likely to obtain recommended screening and care for chronic conditions (Ayanian, Weissman et al. 2000).
  • Relative to the uninsured, insured Americans are less likely to suffer undiagnosed chronic conditions (Ayanian, Zaslavsky et al. 2003).
  • Relative to the uninsured, insured Americans are less likely to receive substandard medical care (Institute of Medicine, 2002).

Who Pays for the Uninsured?

  • Uncompensated Care.
    • People uninsured for any part of 2013 spent about $25.8 billion out of pocket and received approximately $84.9 billion in uncompensated care while uninsured. Thus, of $121 billion in total health spending, 70.2% was uncompensated (Coughlin, et al. 2014).
    • In per capita terms, the average uninsured person in 2013 had $2,742 in total health spending, of which $1257 was paid indirectly through implicit subsidies (calculated as the difference between what uninsured patients paid and insured patients paid for the same services) or other public/private sources. In 2008, assuming part-year uninsured people were uninsured an average of 6 months, per capita total spending while uninsured was $1,429, of which $920 was uncompensated.
    • People uninsured for any part of 2008 spent (in the period they were uninsured) about $30 billion out of pocket and received $54.3 billion in uncompensated care (the latter=64.4% of total spending) (Hadley, et al. 2008).
  • Government-Funded Share of Uncompensated Care.
  • If all uninsured people were fully covered, their medical spending would increase by $122.6 billion. The increase represents 5 percent of current national health spending and 0.8 percent of gross domestic product. However, it is neither the cost of a specific plan nor necessarily the same as the government’s costs, which could be higher, depending on plans’ financing structures and the extent of crowd-out  (Hadley, et al. 2008).

What Are the Health Consequences of Being Uninsured?

What Are the Economic Consequences of Lack of Coverage?

Is Universal Coverage Cost-Effective?

Analysis

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