In the United States, certain groups are more likely than others to lack health insurance coverage. Factors like age, income, employment status, race, ethnicity, citizenship status, and state of residence all impact a person’s likelihood of being uninsured. So who is the least likely demographic to be uninsured in America today?
Children Have the Lowest Uninsured Rates
Children under 18 have the lowest uninsured rates of any age group in the U.S. According to data from the U.S. Census Bureau, just 5.2% of children lacked health insurance coverage in 2020. This compares to 8.6% of adults aged 18-64 and 2.3% of seniors 65 and older who were uninsured.
There are a few key reasons why children have much lower uninsured rates than adults:
- Medicaid and CHIP provide free or low-cost health coverage for children in families with low incomes.
- Children can be covered under a parent’s employer-sponsored health plan up to age 26.
- The Affordable Care Act mandated that health plans allow children to remain on their parents’ plans until age 26.
Medicaid and the Children’s Health Insurance Program (CHIP) have helped drive down uninsurance rates among children over the past two decades. Medicaid covers over 30 million children, while CHIP covers another 6 million kids. Together, these public programs cover 45% of all children in the U.S.
Higher Incomes Correlate with Lower Uninsured Rates
Household income is strongly correlated with insurance status. The uninsured rate declines dramatically as income levels rise. According to data from the Kaiser Family Foundation, people living in poverty are over 3 times more likely to be uninsured than those with incomes above 400% of poverty.
In 2020, the uninsured rate among people living in poverty was 17.7%. For people with incomes between 100-199% of poverty, the uninsured rate dropped to 12.4%. It declined to just 6.3% for individuals earning 400% or more above poverty level.
Higher incomes make it easier for people to afford private health plans or get coverage through an employer. Additionally, the Affordable Care Act’s premium subsidies, which reduce monthly costs for marketplace plans, are only available to those earning between 100-400% of poverty. Americans outside this income range receive less assistance affording coverage.
Uninsured Rates by Income, 2020
| Income Level | Uninsured Rate |
|---|---|
| Below 100% of poverty | 17.7% |
| 100-199% of poverty | 12.4% |
| 200-399% of poverty | 8.7% |
| 400% or more of poverty | 6.3% |
Full-Time Workers Are Less Likely to Be Uninsured
Employment status also impacts the likelihood of being uninsured. Full-time workers are much less likely to be uninsured than part-time workers, the unemployed, and those out of the workforce.
In 2020, just 9.1% of full-time workers lacked health coverage, compared to 19.9% of part-time workers. Further, 30.2% of those unemployed and 13.2% of people out of the workforce were uninsured.
The primary reason is that most Americans get health insurance through an employer. The majority of full-time jobs provide benefits like health insurance, while part-time workers are less likely to receive these benefits. Unemployed individuals lose access to any coverage they had through a job.
Asians Have the Lowest Uninsured Rates by Race/Ethnicity
Significant disparities in insurance rates exist between racial and ethnic groups. According to Kaiser Family Foundation data, Asians had the lowest uninsured rate in 2020 at 7.2%. Just 7.8% of whites lacked coverage.
Compare this to 11.4% of Blacks and 17.8% of Hispanics who were uninsured. Historical discrimination and socioeconomic disparities underlie these differences in coverage rates.
Asians tend to have higher average incomes compared to other minority groups, which enables greater affordability of health plans. Hispanic adults are more than twice as likely to be uninsured as whites, partly due to lower incomes and higher uninsurance rates among non-citizens.
Uninsured Rates by Race/Ethnicity, 2020
| Race/Ethnicity | Uninsured Rate |
|---|---|
| Asian (non-Hispanic) | 7.2% |
| White (non-Hispanic) | 7.8% |
| Black (non-Hispanic) | 11.4% |
| Hispanic (any race) | 17.8% |
Non-Citizens Have Much Higher Uninsured Rates
Health insurance disparities also exist depending on citizenship status. U.S. citizens have an uninsured rate of just 8.1%, compared to 24.4% of non-citizens who lack coverage.
Non-citizens include lawfully present immigrants as well as undocumented immigrants. They have higher uninsurance rates for several reasons:
- Ineligible for Medicaid or CHIP (lawfully present immigrants must wait 5 years before qualifying)
- May not have access to employer-based coverage
- Lower incomes make private coverage unaffordable
- Fear applying for coverage if undocumented
Opening Medicaid/CHIP access to lawfully present immigrants and extending affordability assistance to undocumented immigrants could reduce uninsurance among non-citizens.
States that Expanded Medicaid Have Lower Uninsured Rates
Whether a state expanded Medicaid eligibility under the Affordable Care Act also impacts insurance levels. The uninsured rate in Medicaid expansion states was just 9.7% in 2020, compared to a 17.3% rate in non-expansion states.
Medicaid expansion extends eligibility to adults earning up to 138% of poverty, providing a coverage option for people in this income range. More than 12 million adults have gained Medicaid under the expansion.
Without affordable public insurance options, many low-income adults fall into a “coverage gap” where they earn too much for Medicaid but not enough for marketplace subsidies. This drives higher uninsured rates in states that rejected Medicaid expansion.
Conclusion
While anyone can be at risk of being uninsured, some groups have much lower uninsurance rates than others. Children, higher earners, full-time workers, Asians, citizens, and those living in Medicaid expansion states are the least likely demographics to lack health coverage.
Ensuring affordable coverage options, like Medicaid, CHIP and subsidized marketplace plans, are available for lower-income individuals is key to reducing disparities in insurance rates. Outreach and enrollment assistance can also help connect more people with health plans.