8% of Americans lacked health insurance last year

About 8% of Americans were uninsured in 2024, a rate that held fairly steady over the preceding year, according to new federal data released by the U.S. Census Bureau.

Ninety-two percent were enrolled in some sort of coverage last year, representing about 310 million people. Private health insurance coverage continued to be more prevalent than public coverage, at 66.1% and 35.5%, respectively.

Of the different types of health insurance coverage, employment-based insurance was the most common, covering 53.8% of the population for some or all of the year, followed by Medicare (19.1%), Medicaid (17.6%), direct-purchase coverage (10.7%), TRICARE (2.8%), and VA and CHAMPVA coverage (1.2%).

The private coverage rate increased from 2023 to 2024 by 0.7 percentage points, driven by an increase in direct purchase coverage, the report found. 

Meanwhile, the 2024 public coverage rate was 0.8 percentage points lower than the rate in 2023. This decrease, the report found, was driven by a change in Medicaid coverage, which was 1.3 percentage points lower in 2024. 

Medicare coverage and VA and CHAMPVA coverage rates both increased from 2023 to 2024.

WHAT'S THE IMPACT

Separately, KFF released an analysis of the Census Bureau data, finding that certain provisions of the One Big Beautiful Bill Act would likely increase the uninsured rate over the next 10 years.

While robust Marketplace enrollment helped keep the uninsured rate low in 2024, the expiration of the enhanced premium tax credits for Marketplace enrollees, which will happen at the end of 2025 unless Congress acts to extend them, will increase the number of people without health insurance, KFF said.

The One Big Beautiful Bill Act imposes new work requirements and more frequent eligibility determinations for some Medicaid enrollees, and limits how states can finance their share of Medicaid spending. It also restricts immigrant eligibility for both Medicaid and the subsidized Marketplace coverage, and according to KFF, will make it harder for people to renew Marketplace coverage and enroll in coverage following a change in circumstances. 

CBO estimates that the law will increase the number of people without health insurance by 10.9 million in 2034.

"This projected increase in the number of people who are uninsured would reverse more than a decade of coverage gains under the ACA," KFF wrote. "The impact on access and affordability of healthcare will be significant for those who lose coverage, leading to reduced use of health services, increased financial burden and medical debt, and worse health outcomes."

THE LARGER TREND

On top of the 10.9 million people projected to lose coverage due to the One Big Beautiful Bill Act, CBO estimated in June that another 16 million people would lose health insurance by 2034 under policies affecting the Affordable Care Act. These include the elimination of the premium tax credit at the end of 2025 and the implementation of a proposed Department of Health and Human Services rule regarding coverage that is included in HR 1.

If more people are uninsured, that in turn would add to the amount of uncompensated care for hospitals, CBO said. 

Changes to Medicaid would be expected to increase the number of people without health insurance by 7.8 million in 2034. The increase is due to several proposed provisions, including work requirements.

Few of those disenrolled from Medicaid would have access to employment-based coverage, and none would be eligible for the premium tax credit, the CBO said.