Healthcare access depends on more than having an insurance card. In 2024, 26.7 million people ages 0–64 in the United States were uninsured, while 7.3% of U.S. adults reported not obtaining needed medical care because of cost. Internationally, the OECD reported unmet medical needs linked to cost, distance, or waiting times, and the WHO and World Bank estimated that billions of people still lacked essential health services in 2025.
Contents
- U.S. insurance coverage
- Why people remain uninsured
- Delays, usual care, and affordability
- State and age differences
- International unmet healthcare needs
- Global universal health coverage
U.S. insurance coverage
The KFF Key Facts about the Uninsured Population reports that 26.7 million people ages 0–64 were uninsured in 2024. That was more than 1.3 million higher than the 25.3 million uninsured people in 2023. The uninsured rate for this age group increased from 9.5% in 2023 to 9.8% in 2024, although it remained below the 2019 rate of 10.9%.
Adults accounted for 83.2% of uninsured people under age 65 in 2024, while children accounted for 16.8%. Adults ages 19–44 represented 56.7% of the uninsured population under 65, and people ages 45–64 represented another 26.5%. These shares show that the coverage gap was concentrated primarily among adults rather than children.
Age-specific rates also varied considerably. In 2024, the uninsured rate was 5.9% for children ages 0–18 and 11.1% for adults ages 19–64. Young adults ages 19–25 had a 14.5% uninsured rate, and adults ages 26–34 had a 14.1% rate. Among adults, the 55–64 age group had the lowest uninsured rate at 7.4%.
The following figures use the same KFF source and describe the U.S. population under age 65 in 2024:
| Population group | Uninsured rate or share |
|---|---|
| People ages 0–64 | 9.8% |
| Children ages 0–18 | 5.9% |
| Adults ages 19–64 | 11.1% |
| Young adults ages 19–25 | 14.5% |
| Adults ages 26–34 | 14.1% |
| Adults ages 55–64 | 7.4% |
| Uninsured people who were adults | 83.2% |
Source: KFF, Key Facts about the Uninsured Population.
Why people remain uninsured
Affordability was the most frequently reported reason uninsured adults ages 18–64 gave for lacking coverage. In 2024, 61.7% said coverage was not affordable. Other reported explanations included not being eligible for coverage, difficulty signing up, and not needing or wanting coverage. Specifically, 28.9% said they were not eligible, 21.0% reported difficulty signing up, and 28.0% said they did not need or want coverage. These responses can overlap, so they should not be added together.
Among adults who had not had coverage during the previous three years, 39.7% said they lost a job or changed employers. A further 25.6% said they lost Medicaid, CHIP, or other public coverage eligibility. Other reported causes were an increase in the cost of coverage, missing a sign-up or payment deadline, and losing eligibility because of age or leaving school. Those shares were 19.2%, 15.9%, and 15.0%, respectively.
Employment did not guarantee access to an affordable plan. About 70% of uninsured working adults did not have access to health insurance through their employer in 2024. Within that group, 60.5% worked for an employer that did not offer health insurance, while 9.9% worked for an employer that offered coverage but did not make the person eligible.
The duration of an insurance gap also varied. Nearly seven in ten uninsured adults, or 69.4%, had been without coverage for more than one year in 2024. More than a quarter had been uninsured for ten or more years, while 16.3% had never been insured. Another 30.6% had lacked coverage for less than one year. The figures describe different duration groups and are not a measure of how often people moved in and out of coverage.
Delays, usual care, and affordability
Insurance status was associated with differences in care use and affordability. In 2024, 38.6% of uninsured adults delayed, skipped, or did not get needed care or medication because of cost. Among uninsured adults, 42.0% said their health got worse after skipping or postponing care because of cost. Also, 46.2% of uninsured adults ages 18–64 had not seen a doctor or health professional during the prior 12 months, and 40.8% did not have a regular place to go when sick or seeking medical advice.
Uninsured children experienced different but still substantial access gaps. In 2024, 22.6% had not seen a doctor or health professional during the prior 12 months, 24.4% did not have a regular place for sickness or medical advice, and 16.0% delayed, skipped, or did not get needed care or medication because of cost.
Cost-related delays were lower among insured adults than uninsured adults, but they were not absent. The KFF source reports that 17.0% of adults with private coverage and 18.8% of adults with public coverage delayed, skipped, or did not get needed care or medication because of cost. For children, the comparable figures were 3.3% with private coverage and 3.8% with public coverage.
CDC data provide a broader view of routine access. In 2024, 90.3% of U.S. adults had a source of usual health care, and 88.6% of U.S. persons had a usual place to go for medical care. The CDC FastStats – Access to Health Care reports that 7.3% of U.S. adults failed to obtain needed medical care because of cost.
The CDC Source of Usual Health Care for Adults Age 18 and Older: United States, 2024 reports differences by sex and age. A source of usual health care was reported by 93.3% of women and 87.1% of men. Adults ages 65 and older had the highest reported rate among the listed age groups, at 97.5%, while adults ages 18–34 had a rate of 83.7%.
Doctor’s offices or health centers were the usual source for 77.5% of U.S. adults in 2024. The rate was 82.2% for women and 72.6% for men. Other reported usual sources included urgent care centers or clinics in drug stores or grocery stores at 8.6%, VA medical centers or VA outpatient clinics at 1.5%, and hospital emergency rooms at 1.7%.
State and age differences
Where people live was strongly associated with insurance coverage in the KFF figures. The uninsured rate was 14.5% in Medicaid non-expansion states and 8.0% in Medicaid expansion states in 2024. Of uninsured people ages 0–64, 42.0% lived in the ten non-expansion states, while 58.0% lived in Medicaid expansion states. The population share and the state-level rate measure different things: a larger share of uninsured people can live in expansion states because more people live there overall.
Texas had the highest state uninsured rate at 19.2% in 2024. Massachusetts had the lowest at 3.3%. The KFF source also reports that the uninsured rate for children ages 0–18 rose in nine states from 2023 to 2024. For adults ages 19–64, the rate rose in the District of Columbia and fourteen states during the same period.
These differences matter when interpreting a national average. The national 9.8% rate for people ages 0–64 includes states with rates near one in five as well as states with rates near one in thirty. Age composition, eligibility, employer coverage, and state policy all sit behind the headline number, but the supplied figures quantify the state differences without assigning a separate cause to each state.
International unmet healthcare needs
OECD comparisons measure unmet medical care needs for reasons including cost, distance, or waiting times. Across 26 OECD countries, 2.3% of the population reported an unmet medical care need in 2021. Estonia reported 8.1% and Greece 6.4%, while Germany, the Netherlands, Austria, and the Czech Republic each reported fewer than 0.5%.
Income was an important dividing line in the OECD figures. People in the lowest income quintile were three times more likely to report unmet medical care needs than people in the highest income quintile across the 26 countries in 2021. The gap between the lowest and highest income quintiles exceeded six percentage points in Greece, Latvia, Türkiye, and accession country Romania.
Dental access showed additional differences. More than 7% of people in Portugal, Latvia, Iceland, and Greece reported unmet dental care needs in 2021. In Portugal and Latvia, more than 16% of people in the lowest income quintile reported unmet dental care needs.
Waiting was one specific barrier. Across the 26 OECD countries, 1.4% of people reported waiting times as the main reason for unmet medical care needs in 2021. More than 4% cited waiting times in Estonia, Slovenia, and Finland.
The OECD Unmet healthcare needs: Health at a Glance: Europe 2024 reports that 2.4% of the EU population had unmet medical care needs in 2023. Estonia’s rate was 12.9%. In Greece, 23.0% of people in the lowest income quintile reported unmet medical care needs, compared with 3.4% in the highest quintile. Latvia’s lowest-income-quintile rate was 13.9%, and 21% of people in Greece who had medical care needs said those needs were not met.
Across the EU, unmet medical care needs rose from 1.7% in 2019 to 2.0% in 2021 and 2.4% in 2023. Unmet dental care needs rose from 2.8% in 2019 to 3.1% in 2021 and 3.4% in 2023. These are EU-wide estimates for the stated years, not forecasts.
Global universal health coverage
The WHO defines universal health coverage as access to the full range of quality health services people need, when and where they need them, without financial hardship. The WHO universal health coverage fact sheet says its revised global monitoring framework uses two indicators: SDG 3.8.1 and SDG 3.8.2.
The WHO and World Bank reported in 2025 that 4.6 billion people worldwide still lacked access to essential health services. In the same 2025 estimate, 2.1 billion people experienced financial hardship to access health care, and 1.6 billion people were living in poverty or were pushed deeper into poverty by health expenses.
The WHO universal health coverage fact sheet states that 26% of the world’s population was covered by essential health services, down from 34% in 2000. The WHO 2015 report recommended a minimum target of 80% population coverage of essential health services for universal health coverage. That report also stated that at least 400 million people lacked access to at least one essential health service in 2013.
Taken together, these statistics describe several layers of access: whether coverage exists, whether a person can afford to use it, whether a regular source of care is available, and whether distance or waiting time prevents treatment. The measurement period and geography matter for every comparison, because U.S. insurance figures, OECD unmet-need surveys, EU estimates, and global WHO and World Bank estimates answer related but different questions.