Uninsured

Uninsured in Arizona

Arizona

Health insurance is critical in helping people receive the preventive and medical care they need to achieve and maintain good health. The nation’s uninsured rate dropped significantly after the Affordable Care Act was enacted, yet nearly 28.2 million people were still uninsured in 2021. In 2019, an analysis found that 73.7% of uninsured adults reported that they were uninsured because they could not afford health insurance.

Compared with insured adults, uninsured adults have more health disadvantages, including: 

• Worse health outcomes.
• Higher rates of mortality and premature death.
• Higher rates of cancer mortality and greater risk of a late-stage cancer diagnosis. 
• Inadequate access to quality care, including preventive services. 
• Expensive medical bills due to undiagnosed or untreated chronic conditions.
• More complex emergency room visits. 

One study estimated that adults ages 20-64 in three Medicaid expansion states experienced a 6% decline in all-cause mortality compared with adults living in demographically and economically similar states that did not expand Medicaid. This decline was largely from medical conditions that respond well to medical management, such as HIV, heart disease and diabetes.

Populations with higher uninsured rates include:

• Adults ages 26-34 compared with all other age groups. Older adults ages 55-64 had the lowest rates of being uninsured. 
• American Indian/Alaska Native and Hispanic adults as well as those who identify as other race compared with other racial and ethnic groups. White adults had the lowest rate.
• Adults with less than a high school education compared with those with higher education levels.
• Individuals living in non-Medicaid expansion states compared with those in Medicaid expansion states.
• Individuals with income levels below 100% of the federal poverty level compared with individuals with higher incomes.

Medicaid expansion has decreased uninsured rates among low-income individuals and vulnerable populations in states that have enacted it. In 2019, 45% of the uninsured population did not have access to health coverage provided by the Affordable Care Act because they lived in a state that had not expanded Medicaid, they were not U.S. citizens or their income was too high to be eligible. Additional states adopting the Medicaid expansion could further decrease the number of uninsured individuals. Increasing knowledge of government assistance programs may increase enrollment of eligible individuals. Policy changes can also help address the affordability issue.

Increasing the number of people with health insurance is important to improve health outcomes and decrease health care spending. However, a combination of three core strategies — expanding health insurance coverage, delivering better preventive and chronic care and focusing on community prevention — is more effective at saving lives and money than implementing any of these strategies alone.

A Healthy People 2030 leading health indicator is to increase the proportion of people with health insurance.

Freeman, Joseph D., Srikanth Kadiyala, Janice F. Bell, and Diane P. Martin. “The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies.” Medical Care 46, no. 10 (2008). https://doi.org/10.1097/MLR.0b013e318185c913.

Garfield, Rachel, and Kendal Orgera. “The Uninsured and the ACA: A Primer — Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act.” KFF, January 2019. https://files.kff.org/attachment/The-Uninsured-and-the-ACA-A-Primer-Key-Facts-about-Health-Insurance-and-the-Uninsured-amidst-Changes-to-the-Affordable-Care-Act.

Guth, Madeline, Rachel Garfield, and Robin Rudowitz. “The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review.” KFF, March 17, 2020. https://www.kff.org/medicaid/report/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review/.

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“Return on Investments in Public Health: Saving Lives and Money.” Policy Highlight Brief. Robert Wood Johnson Foundation, December 2013.

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“Strategies for Improving the Affordability of High-Quality Health Care and Coverage.” National Coalition on Health Care, July 10, 2018. https://nchc.org/wp-content/uploads/2018/07/Final-Affordability-Report.pdf.

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Woolhandler, Steffie, and David U. Himmelstein. “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Annals of Internal Medicine 167, no. 6 (June 27, 2017): 424–31. https://doi.org/10.7326/M17-1403.