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Source: US Congressional Budget Office

In 2019, about 12 percent of people under 65 were not enrolled in a health insurance plan or a government program that provides financial protection from major medical risks. In this report, the Congressional Budget Office describes that uninsured population. CBO’s analysis sheds light on groups that were not covered by comprehensive health insurance even during the strong economy and historically low unemployment that preceded the 2020 coronavirus pandemic.

Characteristics and Coverage Options

The uninsured population is heterogeneous, but some groups, including low-income people, were more likely than others to be uninsured in 2019. About two-thirds of uninsured people were eligible for some form of subsidized coverage, although the generosity of available subsidies varied on the basis of people’s family income, access to employment-based coverage, and other factors. A smaller number of uninsured people had no option for coverage except a private plan purchased at full cost.

Financial Liability and Access to Health Care

Uninsured people receive some types of health care and are often not required to pay the full billed charges for that care, but they have substantially less access to care and financial protection than insured people. Uninsured people who are eligible for Medicaid have more financial protection than others because they can enroll without waiting for an open enrollment period—in some cases, as they are seeking care in hospitals or other settings—and may receive coverage retroactively. However, they are still exposed to some financial risk and can have trouble accessing care.

Reasons for Going Without Coverage

Many uninsured people do not enroll in coverage because of the cost; others may not know that they are eligible for subsidized coverage or may be deterred by the complexity of enrolling. Although the majority of uninsured people could obtain coverage for 10 percent or less of their income, they may not view the coverage to be worth the cost.

Length of Time Without Coverage

Most people who were uninsured at a particular point in recent years went without coverage for at least one year. A smaller share lacked coverage for shorter periods.