Health Coverage by Race and Ethnicity, 2010-2024 – Image for illustrative purposes only (Image credits: Pixabay)
The conclusion of pandemic-era Medicaid continuous enrollment policies triggered the first nationwide rise in uninsured rates since 2019, with notable increases among Hispanic, Black, and White individuals under age 65.[1] This shift reversed recent coverage expansions and drew attention to enduring disparities that have defined health insurance trends over the past 15 years. Data from the American Community Survey reveal how policy changes, from Affordable Care Act implementations to recent unwinding processes, shaped access differently across racial and ethnic groups.
Progress and Setbacks: Coverage Evolution Since 2010
Health coverage improved substantially for most groups following the ACA’s major expansions in 2014. Uninsured rates under age 65 dropped sharply between 2014 and 2016, particularly among Hispanic people, whose rate fell 13.5 percentage points to 19.1 percent.[1] Black individuals saw their uninsured rate reach 10.7 percent by 2016, while White rates stood at 7.1 percent.
Those gains eroded somewhat from 2016 to 2019 amid policy reversals, including reduced outreach and stricter enrollment rules. The overall uninsured rate for people under 65 climbed from 10.0 percent to 10.9 percent during this period. Hispanic rates rose 0.9 percentage points to 20.0 percent, and Black rates increased similarly by 0.7 percentage points to 11.4 percent.[1]
Pandemic responses then spurred a rebound. Between 2019 and 2023, the uninsured rate fell to 9.5 percent overall, adding 3.6 million insured individuals under 65. American Indian and Alaska Native (AIAN) people recorded the largest decline, from 21.7 percent to 18.7 percent uninsured. Hispanic and Black rates also decreased by 2.1 and 1.7 percentage points, respectively.[1]
Why 2024 Marked a Turning Point
Uninsured rates rose across several groups in 2024, reaching 9.8 percent overall for those under 65 – a 0.3 percentage point increase that added 1.3 million to the uninsured total of 26.7 million.[1][2] Hispanic people experienced the steepest climb, from 17.9 percent to 18.4 percent uninsured. Black rates followed at 10.1 percent, up 0.4 percentage points, while White rates edged from 6.5 percent to 6.8 percent.[1]
This reversal stemmed primarily from the Medicaid unwinding process, which ended continuous enrollment protections implemented during COVID-19. Renewals led to millions of disenrollments nationwide by late 2024. Although non-group coverage, including ACA Marketplace plans, increased slightly, it failed to fully compensate for Medicaid losses. Employer-sponsored insurance held steady, but public program reductions hit low-income families hardest.[2]
Stark Disparities Define the Landscape
As of 2024, AIAN and Hispanic individuals under 65 faced the highest uninsured rates at 18.9 percent and 18.4 percent, respectively – more than 2.5 times the White rate of 6.8 percent.[1] Native Hawaiian or Pacific Islander (NHPI) rates stood at 12.3 percent, Black at 10.1 percent, and Asian at a low 5.7 percent. These gaps persisted despite overall progress, with relative disparities sometimes widening over time.
Children reflected similar patterns. Hispanic children under 18 had an uninsured rate more than twice that of White children, at roughly 9.8 percent versus 4.4 percent. Over half of children in Hispanic, Black, AIAN, and NHPI families relied on Medicaid or CHIP for coverage.[1]
| Race/Ethnicity | 2019 | 2023 | 2024 |
|---|---|---|---|
| White | 7.8% | 6.5% | 6.8% |
| Hispanic | 20.0% | 17.9% | 18.4% |
| Black | 11.4% | 9.7% | 10.1% |
| AIAN | 21.7% | 18.7% | 18.9% |
| Asian | 7.2% | 5.8% | 5.7% |
Rates for people under age 65; source data adapted from KFF analysis of ACS.[1]
Underlying Drivers of Uneven Access
Income levels played a central role, with over 80 percent of the uninsured in 2024 from families below 400 percent of the federal poverty level. Low-income groups saw the largest rate increases. State Medicaid expansion status amplified differences: non-expansion states had uninsured rates nearly twice as high, at 14.5 percent.[2]
Immigration status further complicated coverage. Noncitizens, who comprised 25.4 percent of the uninsured, faced eligibility barriers like five-year waits or outright exclusions. Among the uninsured, 52.2 percent qualified for Medicaid or subsidized Marketplace plans but encountered enrollment hurdles.[2] Employment patterns also mattered, as 85 percent of uninsured individuals lived in working families, often without affordable employer options.
What Matters Now
- Over 14 million more uninsured projected by 2034 from recent policy shifts, disproportionately affecting people of color reliant on Medicaid and ACA plans.
- Non-expansion states show higher gaps, especially for Hispanic children (16.0 percent uninsured vs. 6.7 percent in expansion states).
- Cost remains the top barrier, cited by 62 percent of uninsured adults.
These patterns underscore the fragility of coverage gains amid shifting policies. While ACA expansions and pandemic measures once narrowed disparities, the 2024 data signals a need for sustained efforts to address structural barriers. Future changes, including expiring Marketplace subsidies, could deepen inequities unless targeted interventions take hold.
