Sally Pipes: "The Real Lesson Of America’s Rising Uninsured Rate"

The following is an excerpt from an article by Sally Pipes, Founder & Chair of the Benjamin Rush Institute, published in Forbes. Click here to read the full article in your browser.

The number of uninsured Americans ticked upward to 26.7 million in 2024, according to an analysis published this month by KFF.

The report’s authors attribute that trend to the “high cost of private insurance and limited availability of public coverage.”

Unpack the numbers, though, and the situation becomes more complicated. The number of uninsured is simply not a useful heuristic for evaluating the U.S. healthcare system.

First, consider just how big the United States is. The number of people without insurance is a tiny fraction of the overall population—about 7.8%.

“Just over half (52.9% or 14.1 million) of uninsured individuals in 2024 were estimated to be eligible for financial assistance either through Medicaid or through subsidized [Obamacare] Marketplace coverage,” the analysis notes.

That fact alone complicates the narrative that coverage is out of reach for most of the uninsured. Most of them could obtain heavily subsidized or fully subsidized coverage under programs that already exist. If they did, the share of Americans without insurance would fall to less than 4%.

The remaining 12.6 million uninsured are largely people who live in states that did not expand Medicaid, are ineligible for federal assistance because of their immigration status or have access to an exchange or employer plan that the law considers affordable.

Some would buy insurance if they felt they could afford it. But other research shows that many Americans are uninsured by choice.

A report from the Centers for Disease Control and Prevention published earlier this year found that one-third of uninsured adults in 2024 did not cite cost as a reason for lacking coverage. Within that group, 44.1% said they did not need or want insurance. Another 21.3% said the enrollment process was too difficult or confusing. Others said they could not find a plan that met their needs.

Those responses suggest that many Americans are uninsured because they do not view the available coverage as worth the cost or hassle.

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