Health care insurance is essential in maintaining physical wellbeing, accessing needed medical services and providing economic security to families and individuals alike. Recently, Americans have seen gains in terms of accessing meaningful coverage due to both government policies and private market programs; yet 28 million still lack meaningful health coverage.

Many Americans obtain health insurance through employment-based plans or individual policies (private sources), public programs such as Medicare and Medicaid, or a combination thereof. This report explores how various private and public sources work together to provide extensive yet incomplete coverage across most of America.

The report explores why people shift between types of insurance or remain uninsured, including age, income, race/ethnicity/family composition/geographic location as well as whether one or more members require special consideration due to special needs within a household.

Additionally, this report investigates how changes to both public and private insurance programs impact both the entire population at large as well as specific groups such as elderly individuals or those with special health care needs, for whom affordable, accessible coverage is especially crucial.

Nearly seven out of ten Americans under 65 who remain uninsured have seen their numbers decrease due to affordable, comprehensive private health insurance (see box). Unfortunately, recessionary trends and increasing costs could compromise these gains; therefore they may not persist even as the economy recovers.

Uninsured individuals are much more likely to forgo medical care, as well as suffering from serious and disabling chronic diseases that could prove costly for both society and health systems alike (Agency for Healthcare Research and Quality 2000). Furthermore, those without coverage are significantly less likely than their insured counterparts to report being in excellent or very good health (Agency for Healthcare Research and Quality 2000).

Some may find that periods without health insurance do not significantly inhibit their ability to seek necessary healthcare (see box). Many working-age Americans, who eventually will qualify for Medicare or other forms of public coverage such as Medicaid, face serious financial risk from having no health coverage at any point during their working lives, including short and long periods without coverage that put both themselves and their communities at financial risk. As health care providers strive to maintain viable practices, offering cost-effective coverage is crucial to their survival. Small and midsized independent practices are particularly affected by declining enrollment in commercial health insurance plans. As a result, healthcare providers are turning more frequently to government programs and the individual market to meet revenue and patient volume requirements – an apparent trend evidenced by the expansion of Affordable Care Act health insurance marketplaces.