The percentage of uninsured Americans has declined over the past decade thanks to the Affordable Care Act (ACA) and historically low unemployment. Still, The US uninsured rate leaves room for improvement, especially among underserved communities and ethnicities. The lack of affordable healthcare has a lasting impact on health, wellness, and financial security and will require substantial change to resolve. 

How Many Americans Are Uninsured?

According to the National Health Interview Survey, approximately 7.7% of the US population, or 25 million people, were uninsured as of Q3 2023. The percentage of uninsured Americans had fallen each year since 2020, when the pandemic’s economic impact contributed to a .5% rise in uninsured citizens. 

The ACA’s Impact on the Uninsured and Healthcare

In the decade preceding the ACA, the US uninsured rate ranged between 14% and 16%. In 2014, four years after the ACA passed, the rate dropped 6.9% from its 2011 high to 9.1%. Few pieces of legislation have had as lasting impact on healthcare access as the ACA, expanding coverage to millions of Americans who otherwise would go without care. 

How Americans Access Health Insurance

Approximately 48.7% of Americans get health insurance through their employer. Employer-based plans often contribute to spikes in the uninsured rate; some of the highest percentages of insured follow economic crises, including the Great Recession and the 2020 pandemic-fueled recession. 21.2% of Americans are insured through Medicaid, with a further 14.6% covered by Medicare. The US’s aging population will shift more seniors to Medicare over the next decade, and dual eligibles (or seniors eligible for both Medicare and Medicaid) will increase as well. 

Related: The Key to Prevention Is Access

Uninsured Individuals in the US: A Snapshot

Uninsured individuals tend to be nonelderly adults in working, low-income households. They tend to be people of color, and most live in the American South or West. Just over a quarter of uninsured Americans are children. 

Despite mischaracterizations, most Americans without healthcare insurance have at least one full-time worker (73.3%). Despite representing 46% of nonelderly adults, minorities account for 62% of the US’s uninsured population. 

Among minority groups, American Indian and Alaskan Natives have the highest uninsured rate, just ahead of Hispanics. 

  • AIAN – 19.1%
  • Hispanic – 18%
  • Native Hawaiian Pacific Islander – 12.7%
  • Black – 10.7%
  • White – 6.6%
  • Asian – 6%

What Causes Lack of Access to Healthcare?

The US healthcare insurance market is fragmented across private and public options. Not all workers are covered by their employers, and many others can’t afford the premiums associated with employee-based plans when available. While Medicaid covers many low-income children, elderly adults don’t qualify for many income-based plans despite being at or slightly above the federal poverty level (FPL), which, for a family of three in 2024 dollars, is just $25,820.

As you’d expect, unaffordable coverage is most Americans’ top barrier to insurance. 

  • Coverage not affordable – 64.2%
  • Not eligible – 28.4%
  • Don’t want/need – 26.1%
  • Difficulty signing up – 22.2%
  • Can’t find a plan that meets needs – 18.5%
  • Lost employment – 4.5%

The Consequences of Lack of Healthcare

Uninsured adults are four times more likely to report not having a normal source of care, such as a primary care physician or clinic access. 47.4% of adults without insurance say they haven’t seen a doctor in the past 12 months, compared to 14% and 16% of public and private insurance holders, respectively. This creates a dangerous barrier to preventative care, which can identify health issues early, such as cancer screening, hypertension, and pre-diabetes. 

Fortunately, there is some momentum at the state level to expand ACA access for low-income households. Several states are also using Medicaid waivers to cover children from birth to age six, regardless of other eligibility factors, including changes in income. 

Access Is Care

At a time of historic divisions, the nation faces a unique opportunity to make incremental but vital improvements in expanded healthcare coverage. Less Cancer knows the importance of preventative care to address cancer and myriad other health challenges. Support our work with a donation and make prevention a priority today.