Why are people uninsured?

Most of the nonelderly in the U.S. obtain health insurance through an employer, but not all workers are offered employer-sponsored coverage or, if offered, can afford their share of the premiums. Medicaid covers many low-income individuals, especially children, and although the Medicaid continuous enrollment provision led to increases in Medicaid coverage in all states, Medicaid eligibility for adults remains limited in most states that have not adopted the ACA expansion. While subsidies for Marketplace coverage are available for many moderate-income people, few people can afford to purchase private coverage without financial assistance.

Key Details:

• Cost still poses a major barrier to coverage for people who are uninsured. In 2022, 64.2% of uninsured nonelderly adults said they were uninsured because coverage is not affordable, making it the most common reason cited for being uninsured . Other reasons included not being eligible for coverage (28.4%), not needing or wanting coverage (26.1%), and signing up being too difficult 
• ot all workers have access to coverage through their job. In 2022, 60.7% of nonelderly uninsured workers worked for an employer that did not offer them health benefits. Among uninsured workers who are offered coverage by their employers, cost is often a barrier to taking up the offer. From 2013 to 2022, total premiums for family coverage increased by 42%, outpacing wage growth, and the worker’s share increased by 39%. Low-income families with employer-based coverage spend a significantly higher share of their income toward premiums and out-of-pocket medical expenses compared to those with income above 200% FPL. Particularly among people working for small employers, premium contributions for dependents can be unaffordable.