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Reasons for being uninsured

September 30, 2020

Topics: Quote of the Day

By Amy E. Cha, Ph.D., M.P.H., and Robin A. Cohen, Ph.D.
CDC, National Center for Health Statistics, September 2020

Data from the National Health Interview Survey

Key findings

  • In 2019, 14.5% of adults aged 18–64 were uninsured in the United States.
  • Among uninsured adults aged 18–64, the most common reason for being currently uninsured was that coverage was not affordable.
  • The percentage of uninsured adults who were uninsured because coverage was not affordable increased with age, from 66.8% among those aged 18–29 to 80.9% among those aged 50–64.
  • Hispanic adults (30.4%) were more likely than non-Hispanic white adults (22.3%) to indicate that they were uninsured due to ineligibility.
  • Men (26.8%) were more likely than women (14.6%) to indicate that they were uninsured because coverage was not needed or wanted.


In 2019, 14.5% of adults aged 18–64 were uninsured at the time of interview. Among uninsured adults aged 18–64, the most common reason for being currently uninsured was because they perceived that they could not afford the cost of coverage, followed by not being eligible, not wanting coverage, the process of signing up was too difficult or confusing, could not find a plan that meets their needs, and they signed up for coverage, but the plan has not started yet. In 2019, the percentage of adults who were uninsured due to cost was higher among women, adults aged 50–64, and adults in fair or poor health. The percentage of adults who were uninsured due to ineligibility did not vary by age but was higher among women and adults in fair or poor health. In contrast, the percentage of adults who were uninsured because coverage was not needed or wanted was higher among men, adults aged 18–29, and adults with excellent, very good, or good health. Individuals without health insurance experience barriers to health care such as not having a usual source of care and postponing or forgoing care due to cost, which may lead to negative health outcomes.



By Don McCanne, M.D.

This report is important because it shows how well (or not) our health care financing system was working under full implementation of the Affordable Care Act but before the onset of the COVID-19 pandemic. It demonstrates that 14.5% of adults under age 65 were uninsured, and the primary reason was the fact that health insurance coverage was not affordable.

This confirms that the current health care financing system is not functioning satisfactorily, so intervention is an imperative.

What choices do we have?

  • Maintain the status quo. No politician supports this, and they shouldn’t because it would perpetuate personal financial hardship, physical suffering and premature death.
  • Continue to implement President Trump’s largely random policies designed to reduce government spending and regulation. The numbers of uninsured will continue to increase and actual health care will continue to be less and less affordable. Financial hardship, suffering and death would increase. Not acceptable.
  • Enact and implement Joe Biden’s proposals for reform that would tweak the current system, leaving in place the Affordable Care Act and possibly adding a public option. Health care spending would increase, the burden of our profound administrative waste would increase, and many would still be left without adequate coverage. It would fail to achieve the goals of universality, affordability and administrative efficiency. We can do better, much better.
  • Enact and implement a well designed, single payer, improved Medicare for All. Coverage for all essential health care services would include absolutely everyone. Since it is funded through equitable progressive taxes, it would be affordable for each of us. The current administrative waste would be largely recovered, returning to society enough funds to pay, through equitable taxes, for the additional care required by those currently uninsured or underinsured. Universal, affordable, equitable, efficient – meeting all of our goals in a system we can afford.

We do need gifted leadership to move forward. Unfortunately that leadership was difficult to identify in last night’s presidential debate. It’s clear the current team has failed us. So do we take our chances on a new team that has already rejected the single payer Medicare for All model? Or might their political position be malleable?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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