Three-quarters of uninsured people are adults (18 to 64 years old), while a quarter of uninsured people are children. Compared to other age groups, young adults are the most likely to be left without coverage. More than 40 percent of the difference in uninsured rates between families with primary earners who have not graduated from high school and families whose primary earners have post-college education would be eliminated if these families were similar demographically, geographically and in terms of health status. Disparities in coverage rates persist between population groups, and not all of these differences can be explained by factors that are commonly measured and that most directly affect the chances of having health insurance.
These expansions left unchanged the principle that non-disabled people between 18 and 64 years old can only be eligible for Medicaid if they are parents living in homes with children. Low-income residents in urban areas with high unemployment rates have a 30 percent employment-based coverage rate compared to a 50 percent rate for those living in areas with low rates of uninsured people, and this disparity between urban areas is maintained even if the identity of racial and ethnic groups and citizenship status are taken into account. Following these unprecedented job losses, many people who have lost their income or employment-based coverage could qualify for the expanded Medicaid and subsidized market coverage established by the ACA. The large number and variety of Americans who do not have health insurance underscore the Committee's conclusion that the voluntary, employment-based approach to insurance coverage in the United States works less as a system and more like a sieve.
At age 65, a person has a minimal chance of being uninsured because Medicare offers nearly universal coverage. An overview of the population without health insurance provides us with an image that reflects the relative size of population groups within the general population under 65 years of age. While financial assistance for Marketplace coverage is available to many people with moderate incomes, few people can afford to buy private coverage without financial assistance. If the court invalidates the ACA, the coverage expansions that were fundamental to the law would be eliminated and would cause millions of people to lose health coverage.
However, young adults may be less likely to buy health insurance coverage and, therefore, more likely to be uninsured than other age groups. This is the age group most likely to report a regular or poor state of health, the presence of a chronic illness, or the presence of a limiting condition or disability (Jensen, 1992; Brennan, 2000). Men are much more likely to be covered by occupational insurance and by Medicare (when certified as having a permanent disability or terminal kidney disease), while women are much more likely to be covered by individual policies and by Medicaid (Brennan, 2000). Much of the high rate of uninsured people among African-Americans is due to a lower rate of employment-based coverage, despite the fact that the top earners in African-American families tend to work for larger companies and in employment sectors with greater coverage (Brown et al.
A quarter of uninsured adults are between 18 and 24 years old; more than a quarter are between 25 and 34 years old; a little less than a quarter are between 35 and 44 years old; the remaining quarter of uninsured adults are between 45 and 64 years old (Figure 3.1) (Fronstin, 2000d). .
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