US Uninsured Population Rises in 2024: KFF Analysis

The number and share of people without health insurance increased in 2024, marking the first such rise since 2019. According to an analysis by KFF using data from the American Community Survey (ACS), the uninsured population reached 26.7 million people, representing a rate of 9.8%.

This trend is primarily driven by a decline in Medicaid coverage as states concluded the process of verifying eligibility for enrollees. This process, known as Medicaid unwinding, began in April 2023 following the end of the continuous enrollment policy that had been maintained during the pandemic.

The Impact of Medicaid Unwinding

During the pandemic, policies paused Medicaid disenrollments to ensure stability in health coverage. Once these policies ended in April 2023, states resumed renewals to verify whether enrollees remained eligible for the program. By the end of 2024, nearly all states had completed these renewals, resulting in the disenrollment of millions of individuals.

Many of the individuals who lost Medicaid coverage did not have access to affordable employer-sponsored health insurance. While some transitioned to subsidized plans through the Affordable Care Act (ACA) Marketplace, others found the options unaffordable, contributing to the overall increase in the uninsured rate.

The Role of ACA Marketplace Subsidies

Growth in ACA Marketplace enrollment helped mitigate the losses experienced in Medicaid. This growth was driven by enhanced premium tax credits originally adopted under the American Rescue Plan Act (ARPA) in 2021 and subsequently extended through the end of 2025 by the Inflation Reduction Act (IRA).

These subsidies have led to record enrollment levels in the Marketplaces, providing a critical safety net for those losing public coverage. However, the subsidies have not been sufficient to offset the total volume of Medicaid disenrollments for all populations.

Barriers to Coverage and Affordability

KFF identifies several systemic factors that continue to leave millions of people without health insurance. A significant barrier is the limited availability of public coverage for low-income individuals in states that have not expanded Medicaid under the ACA.

The complexity of the fragmented health insurance system also means that individuals may lose coverage when they experience changes in their personal or financial circumstances. Beyond the lack of available programs, the high cost of private insurance remains a primary obstacle to maintaining coverage.

The uninsured is not the most politically salient problem in health care now, that’s affordability, nor is it the non-problem some say it is. But it’s coming back. And the problem of the chronically ill uninsured is glaring.

Dr. Drew Altman, President and CEO of KFF

Future Projections for the Uninsured

Current data suggests that the number of uninsured individuals is expected to continue increasing in the coming years. Several factors are contributing to this projection:

• Changes to Medicaid and the ACA Marketplace introduced in the 2025 reconciliation law.
• The scheduled expiration of the enhanced premium tax credits for the Marketplace.
• Various other administrative actions affecting eligibility and enrollment.

These factors combine to create a precarious environment for low-income populations who rely on subsidized or public health coverage to manage chronic diseases and access basic medical care.