About 27 million Americans lacked health insurance in 2024, representing 8% of the population. Put another way, 92% of people in the United States (roughly 310 million) had coverage for some or all of the year, according to the U.S. Census Bureau. That national average, though, masks sharp differences by age, income, race, and where you live.
Who Is Most Likely to Be Uninsured
Working-age adults bear the brunt of the coverage gap. Among adults ages 19 to 64, the uninsured rate was 16.1% in 2023 for those in families earning between one and four times the poverty line. For adults living in poverty, roughly one in four had no coverage at all. Children fare better: the uninsured rate for kids under 19 hovered between 6% and 7% in recent years, partly because Medicaid and the Children’s Health Insurance Program (CHIP) catch many families that fall through the cracks of employer coverage.
Adults 65 and older are largely covered by Medicare, so the uninsured conversation is overwhelmingly about people under 65.
Race and Ethnicity
Coverage rates vary dramatically by race. In the most recent detailed Census breakdown, 17.7% of Hispanic or Latino individuals were uninsured, more than three times the rate for white, non-Hispanic Americans (5.7%). American Indian and Alaska Native people had the highest rate of any single racial group at 18.8%. Black Americans were uninsured at 9.6%, while Asian Americans had one of the lowest rates at 5.8%. These gaps reflect longstanding differences in access to employer-sponsored insurance, eligibility for public programs, and income levels.
Most Uninsured People Live in Working Families
The stereotype that uninsured Americans are unemployed is wrong. In 2024, 85% of uninsured individuals lived in families where at least one person worked. Nearly three in four had a full-time worker in the household. The problem isn’t a lack of employment. It’s that many jobs simply don’t come with benefits.
About 70% of uninsured working adults did not have access to health insurance through their employer. Six in ten worked for a company that didn’t offer coverage at all. Another 10% worked for a company that offered insurance but weren’t eligible, often because they were part-time, temporary, or contract workers. This is a structural gap in the American system: employment and insurance are linked, but millions of jobs don’t actually provide that link.
Why People Go Without Coverage
Cost is the dominant barrier. In 2024, nearly 62% of uninsured adults ages 18 to 64 said they were uninsured because coverage was not affordable. An earlier CDC survey found the number was even higher, with about 74% of uninsured adults citing affordability. The remaining reasons are a mix of practical and bureaucratic obstacles: about 29% said they weren’t eligible for coverage, 21% found the sign-up process too difficult, and 28% said they simply didn’t want or feel they needed insurance.
Losing coverage is also a major pathway to being uninsured. Among adults who had gone without insurance for the past three years, 40% said they lost it because they lost a job or changed employers. About a quarter lost Medicaid or other public coverage because they no longer qualified. Another 19% said their premiums went up and they could no longer keep paying. These transitions, job changes, income fluctuations, missed enrollment deadlines, create gaps that can last months or years.
How the Number Has Changed Over Time
The uninsured population is significantly smaller than it was a decade ago. In 2010, before the major provisions of the Affordable Care Act took effect, 18.2% of the non-elderly population was uninsured. By 2016, that figure had dropped to about 10.8%, a decline of roughly 20 million people. The drop was driven by two main changes: the expansion of Medicaid eligibility in many states and the creation of insurance marketplaces where individuals could buy subsidized plans.
The rate continued to fall through 2022, when it hit historic lows partly because pandemic-era policies prevented states from removing people from Medicaid rolls. When those protections expired in 2023, states began reviewing eligibility again, and the uninsured rate ticked back up. The current rate of about 8% is still far below pre-ACA levels but represents a slight reversal of the post-pandemic gains.
Where You Live Matters
State-level differences in the uninsured rate are enormous, largely driven by whether a state expanded Medicaid. States that accepted the ACA’s Medicaid expansion generally have uninsured rates well below the national average. States that declined the expansion, concentrated in the South, tend to have rates significantly above it. Texas has consistently had the highest uninsured rate of any state, roughly double the national figure. In contrast, states like Massachusetts have rates below 3%.
This creates a “coverage gap” for people in non-expansion states who earn too much to qualify for traditional Medicaid but too little to qualify for marketplace subsidies. These individuals are often left with no affordable option at all.
What Being Uninsured Means for Health
Going without insurance isn’t just a financial category. It changes how people interact with the healthcare system in ways that affect their health. Uninsured adults are less likely to receive preventive screenings for diabetes, cancer, and heart disease. They’re more likely to delay or skip doctor visits, dental care, and prescription medications because of out-of-pocket costs. When they do seek care, they often end up in emergency rooms for conditions that could have been managed earlier and more cheaply.
The effects extend to children. Kids without coverage are less likely to get immunizations, dental care, well-child checkups, and appropriate treatment for chronic conditions like asthma. These aren’t just missed appointments. They’re missed opportunities to catch problems early, when treatment is simpler and outcomes are better.