Despite Affordable Care Act Gains, Millions of Workers Still Lack Health Insurance

While the Affordable Care Act dramatically expanded the availability of health insurance coverage, a new report from the Center for Economic and Policy Research (CEPR) reveals that millions of workers between the ages of 18 and 64 – many of whom are employed full time – do not have insurance coverage, falling into gaps in the law’s reach.

The new research paper – “Chronic Condition: Working Without Health Insuranceout Health Insurance” – finds that almost 16 million workers lacked health insurance for all twelve months of 2023. About 10.2 million of those uninsured workers held full-time jobs.

The paper – authored by CEPR Domestic Outreach and Research Assistant Emma Curchin and Senior Research Fellow John Schmitt – aims to evaluate the demographic characteristics of the uninsured population during the years 2018 through 2023, with specific focus on workers between the ages of 18 and 64 who were employed full time during the whole year.

Among this group, the study finds a striking disparity among racial or ethnic groups. Full time Hispanic workers were far more likely to be uninsured (21.1 percent) than Black (9.1 percent), Asian (5.1 percent) or White full time workers (5.5 percent). There is also a notable gender gap among full time workers; 6.8 percent of women are uninsured, while the rate for men was 10.4 percent.

Full time workers born outside the United States who are not US citizens are far more likely to be uninsured (28.9 percent) than workers who are citizens born in the United States (6.7 percent) and those born abroad (8.6 percent).

Similar disparities exist for educational attainment. The uninsured rate for full time workers with less than a high school degree (32.3 percent) is much higher than those with a degree (13.9 percent). Workers with some college but no degree are almost twice as likely to be uninsured (7.9 percent) than those who finish college (4.0 percent).

There were notable disparities among wage earners. Over 20 percent of full-time workers in the bottom 20 percent of earners lacked insurance; among the highest 20 percent, the uninsured rate was 1.7 percent.

The paper relies on annual Census Bureau survey data. In their methodology, workers are counted as uninsured only if they are without coverage for the entire year, so this overall represents a conservative estimate of the uninsured population.

“The Affordable Care Act has delivered insurance coverage for millions of Americans, but there are still considerable gaps in coverage – particularly for workers who find themselves too young for Medicare and who earn wages above thresholds for Medicaid coverage,” said Emma Curchin, the Domestic Outreach and Research Assistant at CEPR. “These gaps leave millions of people – many of them working full time all year – unable to secure insurance coverage. With so many unsettling questions about the future of key social safety net programs, policymakers must focus on solutions for delivering consistent insurance coverage to everyone.”