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Trends in Selected Reasons for Being Uninsured Among Adults Ages 18–64: United States, 2019–2024
NCHS Health E-Stat 114, March 2026
by Robin A. Cohen, Ph.D., and Abhigya Giri, M.P.H.
Health insurance coverage improves access to and reduces the cost of medical care (1,2). Some studies have examined reasons for being uninsured (3–7). Most of these studies point to affordability as the major reason, with lack of knowledge and complexity of enrollment as other driving factors. However, there is a lack of information on how these reasons may have changed over the last 5 years in light of the COVID-19 pandemic and legislation designed to relieve some of the impact it may have had on uninsured people (8–10). This Health E-Stat describes trends in reasons for being uninsured among currently uninsured adults ages 18–64 from 2019 through 2024.
Among currently uninsured adults ages 18–64, those who reported only affordability as a reason for being uninsured decreased from 28.2% in 2019 to 20.9% in 2024 (Figure, Table 1). Similarly, those who reported affordability along with other additional reasons for being uninsured decreased from 45.7% in 2019 to 41.0% in 2024. In contrast, those who reported only reasons other than affordability increased from 21.7% in 2019 to 33.3% in 2024.
Among the subset of currently uninsured adults ages 18–64 who reported only reasons other than affordability, those who indicated not needing or wanting coverage increased from 40.7% in 2019 to 44.1% in 2024 (Table 2). Similarly, those who indicated the sign-up process was too difficult increased from 17.2% in 2019 to 21.3% in 2024.
Data source and methods
Data from the 2019–2024 National Health Interview Survey, a survey of the U.S. civilian noninstitutionalized population, were used to provide estimates for selected reasons for being uninsured among adults ages 18–64. Reasons for being currently uninsured are based on positive responses to a series of questions asking, “Are you currently uninsured because… ‘coverage is not affordable,’ ‘you do not need or want coverage,’ ‘you are not eligible for coverage,’ ‘the process of signing up for coverage is too difficult or confusing,’ ‘you cannot find a plan that meets your needs,’ and ‘you applied for coverage but it has not started yet’?” An adult may indicate more than one reason for being currently uninsured.
Point estimates and the corresponding confidence intervals are calculated by year for all years. All estimates were evaluated using National Center for Health Statistics presentation standards for proportions (11). Trends by time were evaluated using orthogonal polynomial contrasts. All analyses were conducted using SAS-callable SUDAAN software.
References
- Keisler-Starkey K, Bunch LN, Lindstrom RA. Health insurance coverage in the United States: 2022. U.S. Census Bureau. 2023 Sep;Current Population Reports:P60–281. Available from: https://www.census.gov/library/publications/2023/demo/p60-281.html.
- American Hospital Association. The importance of health coverage. 2019. Available from: https://www.aha.org/system/files/2018-01/report-coverage-overview-2017_0.pdf.
- Patient Protection and Affordable Care Act, Pub. L. No. 111–148, 124 Stat. 119 (2010).
- Congressional Budget Office. Who went without health insurance in 2019, and why? 2020. Available from: https://www.cbo.gov/system/files/2020-09/56504-Health-Insurance.pdf.
- Cha AE, Cohen RA. Reasons for being uninsured among adults aged 18–64 in the United States, 2019. NCHS Data Brief. 2020 Sep;(382):1–8. PMID: 33054924.
- Gunja MZ, Collins SR. Who are the remaining uninsured, and why do they lack coverage? Commonwealth Fund. 2019 Aug. DOI: https://doi.org/10.26099/h0xy-az24.
- Kurth NK, Hall JP. The National Survey on Health and Disability. University of Kansas. 2023. Available from: https://ihdps.ku.edu/nshd.
- Coronavirus Aid, Relief, and Economic Security Act, Pub. L. No. 116–136, 134 Stat. 281 (2020).
- Consolidated Appropriations Act, 2021, Pub. L. No. 116–260, 134 Stat. 1182 (2020).
- American Rescue Plan Act of 2021, Pub. L. No. 117–2, 135 Stat. 4 (2021).
- Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzales JF Jr, et al. National Center for Health Statistics data presentation standards for proportions. Vital Health Stat 2. 2017 Aug;(175):1–22. PMID: 30248016.
Suggested citation
Cohen RA, Giri A. Trends in selected reasons for being uninsured among adults ages 18–64: United States, 2019–2024. NCHS Health E-Stats. 2026 Mar;(114):1–5. DOI: https://dx.doi.org/10.15620/cdc/174654.
Tables
| Reason for being currently uninsured | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
|---|---|---|---|---|---|---|
| Percent (standard error) | ||||||
| Only affordability | 128.2 (26.0–30.4) | 28.6 (26.0–31.3) | 25.0 (22.6–27.4) | 21.1 (18.9–23.4) | 20.8 (18.6–23.1) | 20.9 (18.8–23.1) |
| Affordability plus additional reasons | 145.7 (43.3–48.2) | 44.7 (41.7–47.7) | 44.7 (41.9–47.5) | 43.3 (40.6–46.0) | 42.5 (39.8–45.2) | 41.0 (38.4–43.6) |
| Only reasons other than affordability | 221.7 (19.8–23.8) | 22.7 (20.4–25.3) | 25.2 (22.8–27.6) | 30.6 (28.3–33.0) | 31.6 (28.9–34.3) | 33.3 (30.8–35.9) |
| No reason | 4.3 (3.3–5.5) | 3.9 (2.9–5.2) | 5.2 (4.1–6.5) | 5.1 (4.0–6.3) | 5.1 (4.0–6.5) | 4.8 (3.7–6.1) |
1Significant linear decrease over time.
2Significant linear increase over time.
NOTES: An adult was considered uninsured if they currently did not have coverage through private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), military (TRICARE, VA, and CHAMP-VA), other state-sponsored health plans, or other government programs. Adults were also considered uninsured if they only had Indian Health Service coverage or only had a private plan that paid for one type of service such as dental, vision, or prescription drugs. Percentages may not add to 100 due to rounding. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019–2024.
| Reason other than affordability | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
|---|---|---|---|---|---|---|
| Percent (standard error) | ||||||
| Do not want or need coverage | 140.7 (35.5–46.0) | 37.1 (31.5–42.9) | 40.4 (35.4–45.5) | 42.5 (37.5–47.6) | 45.4 (40.4–50.5) | 44.1 (39.4–48.8) |
| Not eligible for coverage | 28.6 (24.2–33.4) | 32.3 (26.7–38.3) | 31.2 (26.6–36.1) | 33.1 (28.4–38.1) | 30.1 (25.3–35.2) | 31.4 (27.1–35.9) |
| Signing up too difficult | 117.2 (13.3–21.7) | 14.7 (10.6–19.5) | 15.8 (12.0–20.3) | 19.4 (15.5–23.7) | 21.7 (17.5–26.3) | 21.3 (17.6–25.4) |
| Cannot find plan to meet needs | 9.6 (6.9–12.9) | 9.6 (6.6–13.5) | 11.2 (8.2–14.8) | 10.2 (7.6–13.2) | 11.7 (8.7–15.3) | 12.1 (9.2–15.6) |
| Signed up for a plan and waiting to start | 218.2 (14.8–22.1) | 17.0 (13.1–21.5) | 15.7 (12.2–19.7) | 15.0 (11.6–18.8) | 16.8 (13.3–20.8) | 20.6 (16.9–24.7) |
| Other reasons | 220.5 (16.5–24.9) | 25.5 (20.3–31.2) | 21.9 (17.9–26.4) | 18.6 (14.8–22.9) | 20.9 (17.0–25.3) | 11.4 (8.8–14.5) |
2Significant quadratic trend over time.
NOTES: An adult was considered uninsured if they currently did not have coverage through private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), military (TRICARE, VA, and CHAMP-VA), other state-sponsored health plans, or other government programs. Adults were also considered uninsured if they only had Indian Health Service coverage or only had a private plan that paid for one type of service such as dental, vision, or prescription drugs. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population.
SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019–2024.