Health Insurance Coverage

Among the working-age, 26% of American Indians, 25% of Hispanic Americans, and 14% of Black Americans were without health insurance in 2021. Gains in coverage have stalled since 2016.

Lack of health insurance coverage by race/ethnicity

Population age 19-64

Sources: Census Bureau’s American Community Survey. Note: 2020 data is not available. A.N.= Alaska Native. P.I.= Pacific Islander. Data for years prior to 2017 is for the population age 18-64.

Lack of health insurance is one of the reasons that the U.S. has an “excess death” problem.^1,2 Americans without health insurance often fail to get treatment for chronic conditions until they are very ill and go to emergency rooms. From 2010 to 2016, the Affordable Care Act dramatically reduced the number of uninsured people across the country through Medicaid expansion and new subsidies for health insurance “marketplaces.” But progress stalled in 2016 and, among the working-age population, 7% of Asian adults, 8% of white adults, 13% of Native Hawaiian/Pacific Islander adults, 14% of Black adults, 25% of Hispanic adults, and 26% of American Indian/Alaska Native adults still lack health insurance coverage.

In addition, patients who qualify for Medicaid must regularly renew their coverage and periodically verify their eligibility which often leads to patients inadvertently becoming unenrolled. When Covid struck, Congress required that Medicaid keep patients enrolled continuously, a provision which ended in March 2023. Experts estimate 7 million people will lose coverage at some point this year. States with poorly linked data systems are more likely to disenroll eligible individuals. But the largest number of people likely to lose their coverage are individuals who live in the 10 states (6 of them in the South) that have not adopted Medicaid expansion.^3,4

1. “New study finds 45,000 deaths annually linked to lack of health coverage”. Cecere. The Harvard Gazette. September, 2009. https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ 

2. “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Woolhandler, Himmelstein. Annals of Internal Medicine. September, 2017. https://www.acpjournals.org/doi/full/10.7326/M17-1403 

3. “The problem with Medicaid ‘unwinding’”. Harvard T.H. Chan School of Public Health. July, 2023. https://www.hsph.harvard.edu/news/features/the-problem-with-medicaid-unwinding/

4. “Status of State Medicaid Expansion Decisions: Interactive Map”. KFF. July, 2023. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/