Why are there so many uninsured people in the US?

Editorial team Published on

The high cost of health insurance and gaps in the public-private system are the main reasons millions of Americans remain uninsured.

According to data and analysis from KFF, about 9.8% of people under age 65 (26.7 million people) lacked health coverage.

Main Reasons People Are Uninsured

  • High Costs: Over 60% of uninsured adults say coverage is simply too expensive and not affordable. Without financial help, private insurance plans are out of reach for many low- and middle-income families.
  • Lack of Job-Based Coverage: Most non-elderly Americans get insurance through an employer. However, about 70% of working uninsured adults are either not offered coverage by their job or cannot qualify for it.
  • Medicaid Eligibility Gaps: Medicaid provides free or low-cost coverage for millions, but eligibility rules vary. A significant portion of uninsured individuals live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA).
  • Loss of Public Coverage or Jobs: Changes in life circumstances—such as losing a job, changing employers, or aging out of a parent's plan—frequently cause people to drop or lose coverage.
  • Enrollment Barriers: Many people who do not have insurance are actually eligible for free or subsidized plans through the ACA Marketplace or Medicaid, but they face confusion, miss deadlines, or struggle with the sign-up process.

Who pays for uninsured people?

When uninsured people receive medical care they cannot afford, the cost is covered by a mix of government funds, hospitals, and taxpayers.

Government funding pays for roughly 75 to 80 percent of uncompensated care through programs like Medicaid and the Veterans Health Administration. Under federal law via EMTALA, emergency rooms must treat patients who need life-saving care regardless of their ability to pay.

When bills go unpaid, hospitals absorb these costs as uncompensated or charity care. Most users on Reddit agree that society ultimately absorbs the remaining balance through higher overall healthcare costs and taxpayer-funded public programs. Uninsured individuals also pay out-of-pocket for a portion of their care, which often results in severe medical debt.

What percentage of US citizens are uninsured?

About 8.3% of the entire U.S. population (roughly 28.0 million people) did not have health insurance for the year, according to data from the U.S. Census Bureau.

When looking specifically at U.S. citizens (both U.S.-born and naturalized), the uninsured rate is lower at roughly 8.0%, whereas noncitizens face a significantly higher uninsured rate of about 30%.

Key Breakdown of Uninsured Rates

  • Total Population: 8.3% uninsured overall.
  • Working-Age Adults (Ages 18–64): 11.6% uninsured.
  • Children (Ages under 18): 5.6% uninsured.
  • U.S. Citizens: 8.0% uninsured.
  • Noncitizens: ~30.6% to 31.7% uninsured.

What race is the most uninsured?

American Indian and Alaska Native (AIAN) and Hispanic people have the highest uninsured rates in the United States.

According to data from KFF, the uninsured rates for people under age 65 break down as follows:

  • American Indian and Alaska Native (AIAN): 18.9%
  • Hispanic: 18.4%
  • Native Hawaiian and Other Pacific Islander (NHPI): 12.3%
  • Black: 10.1%
  • White: 6.8%
  • Asian: 5.7%

Which state has the most uninsured citizens?

Texas has the highest number and percentage of uninsured residents in the United States.

Key Statistics for Texas

  • Total Uninsured: Over 5.2 million residents lack health insurance.
  • Percentage Uninsured: Approximately 16.7% to 18% of the total state population is uninsured, with adult rates reaching 21.6%.
  • Children Without Coverage: Texas records an uninsured rate of 13.6% for children, meaning nearly 1 in 4 uninsured children in the entire country lives in Texas.

Other States with High Uninsured Rates

Following Texas, the states with the highest uninsured percentages include:

  • Oklahoma
  • Wyoming
  • Florida
  • Georgia

For official state-by-state data and tracking, you can review the U.S. Census Bureau ACS Report.

How Many People are Uninsured?

9 related questions found

Do hospitals lose money on uninsured patients?

Yes, hospitals lose significant money on uninsured patients because they provide billions of dollars in uncompensated care that is never fully paid.

Why Hospitals Lose Money

  • Legal Duty: Under the federal Emergency Medical Treatment and Labor Act (EMTALA), emergency rooms must treat patients who need critical care regardless of their insurance status or ability to pay.
  • Unpaid Bills: Many uninsured patients cannot afford the high cost of medical care, leaving hospitals with unpaid debts and rising uncompensated care totals.
  • Billions in Losses: Industry-wide uncompensated care costs amount to tens of billions of dollars every year, compressing hospital operating margins and driving major financial hits for large health systems.

How Hospitals Handle the Losses

  • Cost Shifting: To stay afloat, hospitals offset these losses by charging higher prices to private insurance companies and patients with commercial coverage.
  • Higher Premiums: Private insurance cost-shifting eventually leads to higher health insurance premiums and increased costs for employers and insured families.
  • Service Reductions: Mounting losses force some hospitals to cut back on essential community services, reduce staff, or delay infrastructure updates.

What country is #1 in healthcare?

Taiwan ranks #1 globally in healthcare on several recent indexes, such as the Numbeo Health Care Index for 2026, thanks to its efficient universal National Health Insurance system and fast access to care.

Depending on the specific organization and metrics used, different countries occasionally take the top spot:

  • Taiwan / South Korea: Frequently lead public indexes like Numbeo and CEOWORLD based on infrastructure, speed, and overall patient satisfaction.
  • Iceland: Ranked #1 in health outcomes and quality of life in publications like U.S. News & World Report Best Countries.
  • Australia and the Netherlands: Frequently top reports from organizations like The Commonwealth Fund for overall performance and equity.

Is it actually cheaper to not have health insurance?

It can be cheaper to go without health insurance for minor, routine care if you are completely healthy, but it is a massive financial risk for major medical emergencies.

When No Insurance Is Cheaper

  • Routine and Predictable Care: If you rarely see a doctor, paying cash for an occasional checkup, generic prescription drug, or lab test can cost less than paying a monthly insurance premium plus a high deductible.
  • Cash Discounts: Some doctors and hospitals offer lower self-pay or cash-only prices because they avoid the paperwork and administrative fees tied to insurance. Studies show that uninsured cash prices for some hospital services are occasionally lower than what insurers negotiate.

The Hidden Financial Dangers

  • Catastrophic Costs: Insurance acts as a safety net. A sudden accident, emergency room visit, or unexpected diagnosis like cancer can lead to hospital bills totaling tens or hundreds of thousands of dollars.
  • No Deductible Credit: Any cash payments you make out-of-pocket do not count toward an annual deductible or out-of-pocket maximum, leaving you with zero financial protection if a health crisis strikes later in the year.
  • State Penalties: Depending on where you live, some states require you to have coverage or face a state tax penalty.

For a deeper look into your options, you can check resources like Newsweek's guide on uninsured care or NBC News on paying for medical care without insurance.

What state is ranked #1 in healthcare?

Hawaii ranks #1 overall for healthcare in the U.S. News & World Report Best States Rankings.

Different organizations use different measures, which change the top-ranked state:

  • U.S. News & World Report: Hawaii ranks #1 overall, performing strongly in healthcare quality and public health.
  • WalletHub: New Hampshire ranks #1 for healthcare, focusing on low costs and health outcomes.
  • The Commonwealth Fund: Massachusetts ranks #1 for health system performance, access, and affordability.

Why are so many Americans uninsured?

The high cost of health coverage and a lack of job-based benefits are the primary reasons many Americans remain uninsured. According to data from KFF, about 62% of uninsured adults say coverage is simply not affordable.

Major Reasons for Being Uninsured

  • High Cost: Premiums, deductibles, and out-of-pocket costs make private insurance and marketplace plans unaffordable for many low- and moderate-income families.
  • Lack of Employer Coverage: Many working-age adults do not get insurance through their jobs. About 70% of uninsured working adults are either not offered coverage or are not eligible for it through their employer.
  • Medicaid Gaps: Eligibility rules leave out poor adults in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA). A significant share of the uninsured population lives in these non-expansion states.
  • Administrative and Enrollment Barriers: Many people face confusing signup processes, struggle to find a plan that fits their needs, or do not know they qualify for financial help or public programs like Medicaid.
  • Loss of Coverage: Job changes, losing eligibility for public programs like Medicaid, or aging off a parent's plan frequently trigger gaps in coverage.