Key Facts about the Uninsured Population

Issue Brief
  1. Robert Hest, Elizabeth Lukanen, and Lynn Blewett, “Medicaid Undercount Doubles, Likely Tied to Enrollee Misreporting Coverage,” (SHADAC, December 2022), https://www.shadac.org/sites/default/files/publications/Medicaid%20Undercount%202020-2021.pdf.

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  2. The Federal Poverty Level was $21,960 for a family of three in 2021.

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  3. Amy E. Cha and Robin A. Cohen, “Demographic Variation in Health Insurance Coverage: United States, 2021,“ National Health Statistics Reports, No. 177,  (Hyattsville, MD: National Center for Health Statistics. 2022).

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  4. KFF analysis of the 2021 National Health Interview Survey.

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  5. 2022 Employer Health Benefits Survey (Washington, DC: KFF, October 2022), https://www.kff.org/health-costs/report/2022-employer-health-benefits-survey/.

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  6. Gary Claxton, Matthew Rae, Nisha Kurani, and Jared Ortaliza, “How affordability of employer coverage varies by family income,” (Health System Tracker, Peterson-KFF, March 2022), https://www.healthsystemtracker.org/brief/how-affordability-of-health-care-varies-by-income-among-people-with-employer-coverage/.

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  7. Two states, Missouri and Oklahoma, implemented the expansion during 2021. Oklahoma implemented the expansion on July 1, 2021 while Missouri Implemented the coverage expansion on October 1, 2021, with coverage retroactive to July 1, 2021. On November 4, 2022, voters in South Dakota approved a ballot measure adopting the Medicaid expansion. The expanded coverage will be implemented on July 1, 2023.

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  8. Health Coverage of Immigrants (Washington, DC: KFF, April 2022), https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/.

     

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  9. Hailun Liang, May A. Beydoun, and Shaker M. Eid, Health Needs, Utilization of Services and Access to Care Among Medicaid and Uninsured Patients with Chronic Disease in Health Centres, Journal of Health Services Research & Policy 24, no. 3 (Jul 2019): 172-181.

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  10. Laura Hawks, et al, “Trends in Unmet Need for Physician and Preventive Services in the United States, 1998-2017,” JAMA Internal Medicine 180, no.3 (Jan. 2020): 439-448, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2759743 .

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  11. Megan B. Cole, Amal N. Trivedi, Brad Wright, and Kathleen Carey, “Health Insurance Coverage and Access to Care for Community Health Center Patients: Evidence Following the Affordable Care Act,” Journal of General Internal Medicine 33, no. 9 (September 2018): 1444-1446.

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  12. Veri Seo, et al., “Access to Care Among Medicaid and Uninsured Patients in Community Health Centers After the Affordable Care Act,” BMC Health Services Research 19, no. 291 (May 2019).

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  13. KFF analysis of 2019 and 2021 National Health Interview Survey.

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  14. KFF analysis of the 2021 National Health Interview Survey.

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  15. Jack Hadley, “Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition,” JAMA 297, no. 10 (March 2007): 1073-84.

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  16. Cesar I. Fernandez-Lazaro, et al., “Medication Adherence and Barriers Among Low-Income, Uninsured Patients with Multiple Chronic Conditions,” Research in Social and Administrative Pharmacy 15, no. 6 (June 2019): 744-753.

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  17. Marco A Castaneda and Meryem Saygili, “The health conditions and the health care consumption of the uninsured,” Health Economics Review (2016).

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  18. Steffie Woolhandler, et al., “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Annals of Internal Medicine 167 (June 2017): 424-431.

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  19. Destini A Smith, et al., “The effect of health insurance coverage and the doctor-patient relationship on health care utilization in high poverty neighborhoods.” Preventive Medicine Reports 7 (2017): 158-161.

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  20. Andrea S. Christopher, et al., “Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured,” American Journal of Public Health 106, no. 1 (January 2016): 63-69.

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  21. Michael G. Usher, et al., “Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study,” Journal of General Internal Medicine 33, no. 12 (December 2018): 2078-2084.

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  22. Aparna Soni, Kosali Simon, John Cawley, and Lindsay Sabik, Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses, American Journal of Public Health epub ahead of print (December 2017), http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304166.

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  23. Sameed Ahmed Khantana et al., Association of Medicaid Expansion with Cardiovascular Mortality, JAMA Cardiology epub ahead of print (June2019), https://jamanetwork.com/journals/jamacardiology/fullarticle/2734704.

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  24. Jonathan Koma et al., Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-Income Adults, Medical Care 55, no. 12 (December 2017): 1023-1029.

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  25. Jessica Sharac, Bradley Corallo, Jennifer Tolbert, Peter Shin, and Sara Rosenbaum, Changes in Community Health Center Patients and Services During the COVID-19 Pandemic, (Washington, DC: KFF, December 2022),

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  26. Allen Dobson, Joan DaVanzo, Randy Haught, and Phap-Hoa Luu, Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not, (New York, NY: The Commonweath Fund, November 2017), https://www.commonwealthfund.org/publications/issue-briefs/2017/nov/comparing-affordable-care-acts-financial-impact-safety-net.

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  27. Margaret B. Greenwood-Ericksen and Keith Kocher, Trends in Emergency Department Use by Rural and Urban Populations in the United States, JAMA Netw Open, April 2019.

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  28. Sherry Glied and Richard Kronick, The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills (Washington, DC: Office of Assistant Secretary for Planning and Evaluation, HHS, May 2011), http://aspe.hhs.gov/health/reports/2011/ValueofInsurance/rb.pdf.

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  29. John W. Scott, et al., Cured into Destitution: Catastrophic Health Expenditure Risk Among Uninsured Trauma Patients in the United States, Annals of Surgery 267, no. 6 (June 2018): 1093-1099.

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  30. “Total expenditures in millions by source of payment and insurance coverage, United States, 2019,” Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2019, https://datatools.ahrq.gov/meps-hc.

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  31. Tim Xu, Angela Park, Ge Bai, Sarah Joo, Susan Hutfless, Ambar Mehta, Gerard Anderson, and Martin Makary, “Variation in Emergency Department vs Internal Medicine Excess Charges in the United States,” JAMA Intern Med. 177(8): 1130-1145 (June 2017), https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2629494%20.

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  32. Stacie Dusetzina, Ethan Basch, and Nancy Keating, “For Uninsured Cancer Patients, Outpatient Charges Can Be Costly, Putting Treatments out of Reach,” Health Affairs 34, no. 4 (April 2015): 584-591, http://content.healthaffairs.org/content/34/4/584.abstract.

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  33. Rebekah Davis Reed, Costs and Benefits: Price Transparency in Health Care, Journal of Health Care Finance (Spring 2019).

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  34. Ashley Kirzinger, Cailey Muñana, Bryan Wu, and Mollyann Brodie, Data Note: American’s Challenges with Health Care Costs, (Washington, D.C.: KFF, June 2019), https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/.

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  35. Lunna lopes, Audrey Kearney, Alex Montero, Liz Hamel, and Mollyann Brodie, Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills, (San Francisco, CA.: KFF, June 2022), https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings/

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  36. Zachary Levinson, Scott Hulver, and Tricia Neuman, Hospital Charity Care: How It Works and Why It Matters, (Washington, D.C.: KFF, November 2022), https://www.kff.org/health-costs/issue-brief/hospital-charity-care-how-it-works-and-why-it-matters/.

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