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Why are There Still Uninsured Families?

Feb 12, 2016

Despite the Affordable Care Act, there are still about 32 million nonelderly uninsured individuals in the US.  About half of these could get coverage under Medicaid or could get help buying insurance through the Affordable Care Act.  Find out why there are still families without coverage and what can be done about it.

African American dad with sonThe Latest Data

An October 2015 analysis by the Kaiser Family Foundation (KFF) found that about 32.3 million people in the US were uninsured and that nearly half of those people, or over 15 million individuals, were either eligible for Medicaid or for financial assistance to help them purchase ACA coverage.  More than 25 percent of the uninsured were adults and children eligible for Medicaid/CHIP, while the remainder were eligible for premium assistance to purchase ACA coverage through the health insurance Marketplace.

Who is Affected?

One reason so many people remain uninsured is that that some states decided against expanding Medicaid coverage.  Nearly 10 percent of the uninsured, or over 3 million people, are in this “coverage gap.”  These people are unlikely to be able to afford to purchase private coverage, but under the ACA they are not eligible for subsidies; under the ACA as written, these people would have received Medicaid benefits, but the Supreme Court made the Medicaid expansion optional for states.  

Ten percent of the uninsured (over 3 million) are children who are eligible for but not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).  Another 20 percent of the uninsured are Medicaid-eligible adults who are not enrolled.

The uninsured population also includes undocumented immigrants, who are not permitted to purchase insurance through an Exchange or receive subsidies.  Some other immigrants must wait five years to be eligible for Medicaid.  It is important to note that while some parents may not be eligible for Marketplace plans or Medicaid, in mixed immigration-status families the children could still be eligible for premium subsidies or Medicaid/CHIP.  

Another group of uninsured individuals are those who are not eligible for premium subsidies because their incomes are too high or because they have an offer of insurance from their employer.

Eligivility for ACA Coverage Among Nonelderly Uninsured as of 2015, by State Medicaid Expansion Status

Healthcare implications

The Kaiser Family Foundation developed a primer on the uninsured, which discusses reasons for the lack of coverage and the health implications of not having insurance.  According to the primer, “The access barriers facing uninsured people mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance.”  

Although the number of uninsured significantly declined due to the ACA, many are still without insurance coverage.  There are many misconceptions as to who is uninsured.  The primer smashes some of these myths and notes that “A majority of the remaining uninsured population is in a family with at least one worker, and many uninsured workers continue to lack access to coverage through their job.”

Characteristics of the Nonelderly Uninsured, 2014

What Can be Done?

“The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels…”

Source: KFF Primer on the Uninsured

According to the KFF primer, “Some of these [uninsured] children may be reached by covering their parents, as research has found that parent coverage in public programs is associated with higher enrollment of eligible children.”i   Although non-citizens are at higher risk of being uninsured, most of the uninsured are citizens.  Reaching out to mixed immigration-status families will also increase enrollment.  Many of the uninsured are concerned with cost, so awareness needs to be raised about tax credits for premiums and how to save on out-of-pocket costs (see Resources).  By sharing this information with our family, friends, and neighbors, we can help contribute to getting more people covered.

With continued efforts to educate and enroll the uninsured, forthcoming enrollment data will show progress in this area.  The primer concludes, “The ACA has provided coverage to millions of people in the United States in its first two years and has the potential to reach many more, ensuring that fewer individuals and families will face the health and financial consequences of not having health insurance.”


  1. - lower costs:
  2. Kaiser Family Foundation report on the uninsured: 
  3. The Uninsured -- A Primer by Kaiser Family Foundation: 
  4. Georgetown University Center for Children and Families blog:

i  Benjamin Sommers, “Insuring children or insuring families: do parental and sibling coverage lead to improved retention of children in Medicaid and CHIP?” Journal of Health Economics 25 no.6 (November 2006): 1154-69


Lauren Agoratus


Lauren Agoratus is the parent of a child with multiple disabilities who serves as the NJ Coordinator for Family Voices. She also serves as the southern coordinator in her state’s Family-to-Family Health Information Center.

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