Uninsured Women

Uninsured Women in United States

United States

Health insurance is a critical factor in ensuring women receive the preventive and medical care they need to achieve and maintain good health. Compared with insured women, uninsured women have more health challenges, including:

• Inadequate access to care.
• Lower quality of care. disadvantages
• Unmet need for medical care due to cost.
• Lower use of recommended preventive services such as mammograms and Pap tests for cancer screening.
• Poorer health outcomes, such as higher rates of cancer mortality and greater risk of a late-stage cancer diagnosis.

Since the implementation of the Affordable Care Act in 2010, the proportion of women of reproductive age who are uninsured has declined. States that expanded Medicaid showed greater progress in reducing their uninsured population; in 2019, the proportion of uninsured women in expansion states was 8%, compared with 17% in states that did not expand Medicaid.

 The uninsured rate is higher among:

• Single mothers compared with women in two-parent households.
• Hispanic and American Indian/Alaska Native women compared with Asian and white women.
• Low-income women compared with high-income women. 
• Women living in the United States without U.S. citizenship compared with those with U.S. citizenship.
• Younger women compared with older women. 

Common reasons for being uninsured include the cost of insurance, lack of knowledge about eligibility for free- or reduced-cost insurance, and falling into the coverage gap. It is estimated that 800,000 women of reproductive age were in the Medicaid coverage gap in 2019. This is particularly a problem in states that chose not to expand Medicaid under the Affordable Care Act.

Public programs that have been effective at reducing the rate of uninsured women include:

• Expanding Medicaid: This government-sponsored health insurance program has made significant strides in increasing access to care and improving health status and quality of care for low-income women and those who would otherwise lack coverage. Expansion of Medicaid eligibility will decrease the proportion of uninsured women.  
• Pregnancy-related Medicaid: Pregnancy care through Medicaid covers maternity care, delivery and postpartum care for 60 days after childbirth, and is available in all 50 states. Women can enroll in pregnancy-related Medicaid at any time during pregnancy, but must meet their state’s income requirements to be eligible. The National Health Law Program provides answers to frequently asked questions regarding eligibility for pregnancy-related Medicaid. States now have the option to expand Medicaid postpartum coverage from 60 days to 12 months through provisions in the American Rescue Plan Act of 2021. 

Healthy People 2030 has several health insurance-related objectives, including increasing the proportion of people with health insurance and reducing the proportion of people who can’t get medical care when they need it.

Increasing access to and coverage of high-quality maternal health services is one of five goals in the White House Blueprint for Addressing the Maternal Health Crisis, released in June 2022. The document outlines strategies the federal government should take to improve U.S. maternal and infant health outcomes.

Garfield, Rachel, Kendal Orgera, and Anthony Damico. 2020. “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Issue Brief. KFF. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.

Gunja, Munira Z., Sara R. Collins, Michelle M. Doty, and Sophie Beautel. 2017. “How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016.” Issue Brief. The Commonwealth Fund. https://doi.org/10.15868/socialsector.28134.

Salganicoff, Alina, Usha Ranji, Adara Beamesderfer, and Nisha Kurani. 2014. “Women and Health Care in the Early Years of the Affordable Care Act: Key Findings from the 2013 Kaiser Women’s Health Survey.” Issue Brief. KFF. https://www.kff.org/womens-health-policy/report/women-and-health-care-in-the-early-years-of-the-aca-key-findings-from-the-2013-kaiser-womens-health-survey/.

Silvestri, Gerard A., Ahmedin Jemal, K. Robin Yabroff, Stacey Fedewa, and Helmneh Sineshaw. 2021. “Cancer Outcomes Among Medicare Beneficiaries And Their Younger Uninsured Counterparts: Study Compares Cancer Outcomes among Medicare Beneficiaries and Their Younger Uninsured Counterparts.” Health Affairs 40 (5): 754–62. https://doi.org/10.1377/hlthaff.2020.01839.

Solomon, Judith. 2021. “Closing the Coverage Gap Would Improve Black Maternal Health.” Washington, D.C.: Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/closing-the-coverage-gap-would-improve-black-maternal-health.

Tolbert, Jennifer, Kendal Orgera, Natalie Singer, and Anthony Damico. 2019. “Key Facts about the Uninsured Population.” Issue Brief. KFF. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.