About 8% of Americans don’t have health insurance. In the first quarter of 2024, the national uninsured rate stood at 8.2%, meaning roughly 27.1 million people lacked coverage. The U.S. Census Bureau confirmed a similar figure for 2023, reporting that 92% of the population (305.2 million people) had insurance for at least part of the year.
That 8% figure represents a national average, though, and the reality varies dramatically depending on where you live, how much you earn, and your racial or ethnic background.
Who Is Most Likely to Be Uninsured
Among people under 65, Hispanic Americans face the highest uninsured rate at 19.8%, nearly three times the rate for non-Hispanic white Americans (6.9%). Black Americans are uninsured at a rate of 8.4%, while Asian Americans have the lowest rate at 4.9%.
Income plays an equally large role. Among people earning below the federal poverty level, about 16.5% are uninsured. The rate is nearly identical for those earning between 100% and 199% of the poverty level (roughly $31,000 to $62,000 for a family of four). Once household income climbs above that range, uninsured rates drop sharply.
Children are more likely to have coverage than adults. The uninsured rate for kids under 19 hovered between 6% and 7% in recent years, largely because Medicaid and the Children’s Health Insurance Program cover a broad swath of lower-income families. Working-age adults between 19 and 64 consistently have higher uninsured rates than any other age group, in part because they fall into gaps between employer coverage, Medicaid eligibility, and marketplace plans.
Why Your State Matters
The single biggest geographic factor is whether your state expanded Medicaid under the Affordable Care Act. Among working-age adults, states that expanded Medicaid had an uninsured rate of 9.8%, compared to 18.4% in states that did not. That gap, nearly double, means millions of low-income adults in non-expansion states earn too much for traditional Medicaid but too little to afford marketplace plans, leaving them with no realistic path to coverage.
Why 27 Million People Still Lack Coverage
Cost is the dominant barrier. In CDC survey data, roughly 7 in 10 uninsured adults (73.7%) said they didn’t have coverage because they couldn’t afford it. The next most common reasons were not being eligible for any plan (25.3%), not wanting or feeling they needed coverage (21.3%), finding the sign-up process too difficult or confusing (18.4%), and being unable to find a plan that fit their needs (18%). Some respondents cited more than one reason, which is why these figures add up to more than 100%.
Employer coverage gaps also contribute. Workers at small businesses (fewer than 25 employees) are far less likely to be offered health benefits than those at large firms with 500 or more employees. Large employers are roughly 10 times more likely to offer insurance than the smallest ones. Even among large-firm workers, though, coverage isn’t guaranteed: some aren’t offered benefits because of part-time status or waiting periods, and others can’t afford the employee share of premiums.
How the Uninsured Rate Got to 8%
The current rate represents a historic low point for the United States. Before the Affordable Care Act’s major coverage provisions took effect in 2014, the uninsured rate for the full population was consistently in the mid-to-high teens. The combination of Medicaid expansion, marketplace subsidies, and the requirement to carry insurance brought millions into the system over the following decade.
The rate dipped further during the COVID-19 pandemic, when Congress paused Medicaid eligibility reviews. States couldn’t remove anyone from their rolls regardless of whether they still qualified. When that pause ended in 2023, states began a massive “unwinding” process to reassess every enrollee. The Congressional Budget Office estimated that 6.2 million people losing Medicaid through this process would end up uninsured, accounting for about 40% of those disenrolled. Many of the rest transitioned to marketplace plans or employer coverage, but the unwinding put upward pressure on the uninsured rate heading into 2024.
What Being Uninsured Actually Costs
People without insurance pay the full sticker price for medical care, which is often several times what insurers negotiate. A single emergency room visit can run $2,000 or more, and a short hospital stay can produce bills in the tens of thousands. Beyond the financial exposure, uninsured people are less likely to get preventive screenings, manage chronic conditions like diabetes or high blood pressure, or fill prescriptions consistently. Over time, that delayed care leads to worse health outcomes and, paradoxically, higher costs when problems become emergencies.
If you’re currently uninsured, the federal marketplace at HealthCare.gov (or your state’s exchange) is the main route to subsidized coverage. Depending on your income, premium tax credits can reduce monthly costs to under $50 or even $0. Medicaid applications are accepted year-round, and marketplace special enrollment periods open after qualifying life events like losing a job, moving, or having a child.