For-Profit US Health System Continues to Leave Many Millions Uninsured Each Year

More than 10 million workers in the United States who held full-time jobs in 2023 still lacked health insurance for the entire year.

That's just one of the troubling findings from a report released Friday which fleshes out how America's "patchwork" system of employer-provided plans, individually purchased coverage through state-level exchanges, and Medicaid, are leaving many millions of Americans without care year after year.

The new study by the Center for Economic and Policy Research (CEPR) looked at the demographic characteristics of the uninsured population from 2018 through 2023 using Census Bureau data and found lack of healthcare coverage along class, racial, and ethnic lines, as well as disparities when it comes to levels of educational attainment.

"The Affordable Care Act has delivered insurance coverage for millions of Americans, but there are still considerable gaps in coverage—particularly for workers who find themselves too young for Medicare and who earn wages above thresholds for Medicaid coverage," said Emma Curchin, one of the authors of the paper and a research assistant at CEPR.

"These gaps leave millions of people—many of them working full time all year—unable to secure insurance coverage. With so many unsettling questions about the future of key social safety net programs, policymakers must focus on solutions for delivering consistent insurance coverage to everyone," she added.

After it passed in 2010, the Affordable Care Act—which sought to expand health insurance coverage, including by creating nex exchanges in the for-profit market—was able to reduce the share of the U.S. population that was without health insurance by roughly half between 2009 and 2023. While 16.7% of the population lacked insurance in 2009, the latest available data shows 8% of the population is without insurance. But even with the ACA, the study found that more than 27 million U.S. residents are without insurance, and almost 16 million workers have full-time jobs, part-time jobs, or are unemployed but actively seeking work.

The report, which focused on workers between the ages of 18 and 64 found that among full-time, year-round workers, Hispanic workers were most likely to be uninsured (21%). The rate of being uninsured among that group was about four times higher than the corresponding rate for Asian or white workers, which stood at 5.1% and 5.5%, respectively.

Unmarried people are more likely to be uninsured than married people, and full-time workers who live in a household with a child or children are less likely to be uninsured—which "may reflect the greater likelihood that households with children are eligible for Medicaid, because Medicaid eligibility is determined in part by income relative to household size," according to the authors of the study.

For all worker types, higher educational attainment means lower rates of being uninsured, the researchers found. Someone who works full-time and full-year but has less than a high school degree has an uninsured rate 15 higher than a worker with an advanced degree. Workers who complete some of college but do not hold a degree are almost twice as likely to uninsured compared to those who do finish with a degree.

Across racial and ethic groups and levels of educational attainment men consistently have higher uninsured rates than women.

Other findings include that uninsured rates declined as wages increased. 21.4% of full-time, full-year workers in the bottom of the wage distribution lack health insurance, compared with only 1.7% for workers who are in the top wage quintile. Whether you were born inside the U.S. and citizenship status also play a large role in uninsured rates. 28.9% of full-time, full-year workers who were born in a different country and are not citizens are uninsured, but only 6.7% of full-time, full year workers born in the U.S. are uninsured, and 8.6% of these types of workers who were born abroad but who hold U.S. citizenship are uninsured.

What's more, "lack of coverage is particularly acute for part-time or part-year and unemployed non-citizen workers: 36% of part-time workers and 39% percent of unemployed workers are uninsured," the researchers note.