The State of U.S. Health Insurance in 2023

Findings from the Commonwealth Fund Biennial Health Insurance Survey

The State of U.S. Health Insurance in 2022

The number and percentage of Americans lacking health insurance is falling to historic lows, thanks to policy changes aimed at helping people get and stay covered during the COVID-19 pandemic, as well as the recent decision by several states to expand Medicaid eligibility under the Affordable Care Act. Still, a large number of people in the United States remain uninsured or inadequately covered, a situation that will worsen when some temporary pandemic measures expire.

In this data brief, we present findings from the Commonwealth Fund Biennial Health Insurance Survey to describe the state of Americans’ health insurance coverage in 2022. We answer the following questions:

• How many people experience gaps in their coverage, and how long are those gaps?
• How many people have insurance but are underinsured?
• Are health care costs affecting people’s decision to get needed care?
• Are these costs leaving people with medical bills they cannot pay?

For the survey, SSRS interviewed a nationally representative sample of 8,022 adults age 19 and older between March 28 and July 4, 2022. This analysis focuses on 6,301 respondents under age 65. Note that because the 2022 edition of the Biennial Health Insurance Survey employed a new sampling method and was conducted mostly online rather than by telephone, as in the past, we are unable to present data on trends in responses over the years. To learn more about our survey, including the revised sampling method, see “How We Conducted This Survey.”

Survey Highlights

• Forty-three percent of working-age adults were inadequately insured in 2022. These individuals were uninsured (9%), had a gap in coverage over the past year (11%), or were insured all year but were underinsured, meaning that their coverage didn’t provide them with affordable access to health care (23%).
• Twenty-nine percent of people with employer coverage and 44 percent of those with coverage purchased through the individual market and marketplaces were underinsured.
• Forty-six percent of respondents said they had skipped or delayed care because of the cost, and 42 percent said they had problems paying medical bills or were paying off medical debt.
• Half (49%) said they would be unable to pay for an unexpected $1,000 medical bill within 30 days, including 68 percent of adults with low income, 69 percent of Black adults, and 63 percent of Latinx/Hispanic adults.
• Sixty-eight percent of Democrats, 55 percent of Independents, and 46 percent of Republicans said President Biden and Congress should make health care costs a top priority in the coming year.

Who Is Underinsured?

For our analysis, people who are insured all year are considered to be underinsured if their coverage doesn’t enable affordable access to health care. That means at least one of the following statements applies:

• Out-of-pocket costs over the prior 12 months, excluding premiums, were equal to 10 percent or more of household income.
• Out-of-pocket costs over the prior 12 months, excluding premiums, were equal to 5 percent or more of household income for individuals living under 200 percent of the federal poverty level ($27,180 for an individual or $55,500 for a family of four in 2022).
• The deductible constituted 5 percent or more of household income.

Because out-of-pocket costs occur only if a person uses their insurance to obtain health care, we also consider the deductible when determining whether someone is underinsured. The deductible is an indicator of the financial protection that a health plan offers as well as the risk of incurring costs before a person gets health care. We do not, however, consider the risk of incurring high costs owing to an insurance plan’s other design features, such as out-of-pocket maximums, copayments, or uncovered services, since we do not ask about these features in the survey.