NCHS Data Brief ■ No. 382 ■ September 2020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Reasons for Being Uninsured Among Adults Aged 18–64 in 

the United States, 2019

Amy E. Cha, Ph.D., M.P.H., and Robin A. Cohen, Ph.D.

Key findings

Data from the National 

Health Interview Survey

● In 2019, 14.5% of adults 

aged 18–64 were uninsured in 

the United States.

● Among uninsured adults 

aged 18–64, the most common 

reason for being currently 

uninsured was that coverage 

was not affordable.

● The percentage of uninsured 

adults who were uninsured 

because coverage was not 

affordable increased with age, 

from 66.8% among those aged 

18–29 to 80.9% among those 

aged 50–64.

● Hispanic adults (30.4%) 

were more likely than 

non-Hispanic white adults 

(22.3%) to indicate that 

they were uninsured due to 

ineligibility.

● Men (26.8%) were more 

likely than women (14.6%) 

to indicate that they were 

uninsured because coverage 

was not needed or wanted.

Previously published data from the National Health Interview Survey (NHIS) 

reported that the percentage of uninsured adults aged 18–64 significantly 

decreased from 20.4% in 2013 to 13.3% in 2018 (1). Lack of health insurance 

has been associated with not receiving preventive services or screenings and 

may, in turn, lead to delays in disease diagnosis and poorer health outcomes 

(2). The 2019 NHIS included six questions for uninsured adults to better 

understand their reasons for currently being uninsured. This report describes 

the characteristics of uninsured adults aged 18–64 in 2019 and the percentage 

who identified with each of the six reasons for being uninsured. For the three 

most prevalent reasons, the percentage who identified with each reason is 

presented by selected demographic characteristics, and health status.

The percentage of adults aged 18–64 who were uninsured 

varied by selected characteristics.

1Significantly different from women (p < 0.05). 2Significant linear trend by age group (p < 0.05). 3Significantly different from non-Hispanic white adults (p < 0.05). 4Significantly different from non-Hispanic black adults (p < 0.05). 5Significantly different from adults in fair or poor health status (p < 0.05).

NOTE: Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db382-tables-508.pdf#1. 

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

Figure 1. Percentage of adults aged 18–64 who were uninsured at the time of interview, by 

selected characteristics: United States, 2019

0 10 20 30 40

Fair or poor

Excellent, very good, or good

3,430.2

Non-Hispanic black

Non-Hispanic white

Hispanic

50–64

30–49

18–29

Women

Men

Total

Percent

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
NCHS Data Brief ■ No. 382 ■ September 2020

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● Among adults aged 18–64, 14.5% were uninsured at the time of interview, and men (16.0%) 

were more likely than women (13.1%) to be uninsured (Figure 1).

● The percentage of adults who were uninsured decreased with age, from 17.5% among those 

aged 18–29 to 10.5% among those aged 50–64.

● Hispanic adults (30.2%) were more likely than non-Hispanic black (14.3%) and 

non-Hispanic white (10.2%) adults to be uninsured. Non-Hispanic black adults were more 

likely than non-Hispanic white adults to be uninsured.

● Adults in fair or poor health (17.6%) were more likely than adults in excellent, very good, or 

good health (14.1%) to be uninsured.

Among adults aged 18–64, the reasons for being uninsured included not 

affordable, not eligible, do not need or want, signing up was too difficult 

or confusing, cannot find plan that meets needs, and applied but has not 

started.

● Among uninsured adults aged 18–64, the most common reason for being uninsured, 

affecting approximately 7 in 10 (73.7%), was because they perceived that coverage was not 

affordable (Figure 2).

8.5

18.0

18.4

21.3

25.3

73.7

0 20 40 60 80 100

Percent

Not affordable

Not eligible

Do not need or want

Signing up was too

 difficult or confusing

Cannot find a plan

 that meets needs

Applied but has not started

NOTES: “Not affordable,” “Do not need or want,” “Not eligible,” “Signing up was too difficult or confusing,” “Cannot find plan that meets needs,” and “Applied but 

has not started” are based on positive responses to a series of questions asking, “Are you currently uninsured because ... ‘coverage is not affordable,’ ‘you do not 

need or want coverage,’ ‘you are not eligible for coverage,’ ‘the process of signing up for coverage is too difficult or confusing,’ ‘you cannot find a plan that meets 

your needs,’ and ‘you applied for coverage, but it has not started yet?’” A sample adult can provide more than one reason for being currently uninsured. Access 

data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db382-tables-508.pdf#2.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

Figure 2. Percentage of adults aged 18–64 who identified with selected reasons for being currently uninsured: 

United States, 2019
NCHS Data Brief ■ No. 382 ■ September 2020

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● Among uninsured adults aged 18–64, 25.3% indicated that they were not eligible for 

coverage, followed by not needing or wanting coverage (21.3%), signing up was too 

difficult or confusing (18.4%), could not find a plan that meets their needs (18.0%), and 

applied for coverage, but it has not started yet (8.5%).

The percentage of adults aged 18–64 who were uninsured because 

coverage was not affordable varied by selected characteristics.

● Women (77.4%) were more likely than men (70.8%) to be currently uninsured due to 

coverage affordability (Figure 3).

● The percentage of adults who were currently uninsured because coverage was not 

affordable increased with age, from 66.8% among those aged 18–29 to 80.9% among those 

aged 50–64.

● Non-Hispanic white adults (76.3%) were more likely than Hispanic adults (71.1%) to be 

currently uninsured because coverage was not affordable. However, the observed difference 

between Hispanic (71.1%) and non-Hispanic black (75.8%) adults, was not statistically 

significant.

● Adults in fair or poor health (85.1%) were more likely to be uninsured due to affordability 

than those in excellent, very good, or good health (71.7%).

Figure 3. Percentage of adults aged 18–64 who were uninsured because coverage was not affordable, by selected 

characteristics: United States, 2019

1Significantly different from women (p < 0.05). 2Significant linear trend by age group (p < 0.05). 3Significantly different from non-Hispanic white (p < 0.05). 4Significantly different from adults in fair or poor health status (p < 0.05).

NOTES: “Uninsured due to cost” is based on a positive response to a question asking, “Are you currently uninsured because coverage is not affordable?”

Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db382-tables-508.pdf#3.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

0 20 40 60 80 100

Fair or poor 85.1

4 Excellent, very good, or good 71.7

75.8

76.3

371.1

Non-Hispanic black

Non-Hispanic white

Hispanic

80.9

75.2

266.8

50–64

30–49

18–29

77.4

170.8

Women

Men

Total 73.7

Percent
NCHS Data Brief ■ No. 382 ■ September 2020

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The percentage of adults aged 18–64 who were uninsured because they 

were not eligible for coverage varied by selected characteristics.

● Women (28.1%) were more likely than men (23.1%) to be currently uninsured because they 

were not eligible for coverage (Figure 4).

● The percentage of adults who were currently uninsured because they were not eligible for 

coverage was higher among Hispanic (30.4%) than non-Hispanic white (22.3%) adults. 

However, the observed difference between Hispanic (30.4%) and non-Hispanic black 

(25.3%) adults was not statistically significant.

● Adults in fair or poor health (34.1%) were more likely than those in excellent, very good, or 

good health (23.8%) to be uninsured because they were not eligible for coverage.

Figure 4. Percentage of adults aged 18–64 who were uninsured because they were not eligible for coverage, by selected 

characteristics: United States, 2019

1Significantly different from women (p < 0.05). 2Significantly different from non-Hispanic white adults (p < 0.05). 3Significantly different from adults in fair or poor health status (p < 0.05).

NOTES: “Uninsured due to ineligibility” is based on a positive response to a question asking, “Are you currently uninsured because you are not eligible for 

coverage?” Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db382-tables-508.pdf#4.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

0 10 20 30 40

Fair or poor

Excellent, very good, or good

Non-Hispanic black

Non-Hispanic white

Hispanic

50–64

30–49

18–29

Women

Men

Total

Percent
NCHS Data Brief ■ No. 382 ■ September 2020

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The percentage of adults aged 18–64 who were uninsured because 

coverage was not needed or wanted varied by selected characteristics.

● Among uninsured adults aged 18–64, men (26.8%) were more likely than women (14.6%) 

to be currently uninsured because coverage was not needed or wanted (Figure 5).

● The percentage of adults who were currently uninsured because coverage was not needed 

or wanted decreased with age, from 24.0% among those aged 18–29 to 17.5% among those 

aged 50–64.

● Among uninsured adults aged 18–64, those in excellent, very good, or good health (23.2%) 

were twice as likely as those in fair or poor health (11.1%) to indicate that they were 

uninsured because coverage was not needed or wanted.

● The percentage of adults who were currently uninsured because coverage was not needed or 

wanted did not differ significantly by race and ethnicity.

1Significantly different from women (p < 0.05). 2Significant linear trend by age group (p < 0.05). 3Significantly different from adults in fair or poor health status (p < 0.05).

NOTES: “Uninsured because it is not needed or wanted” is based on a positive response to a question asking, “Are you currently uninsured because you do not 

need or want coverage?” Access data table for Figure 5 at: https://www.cdc.gov/nchs/data/databriefs/db382-tables-508.pdf#5.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2019.

0 10 20 30 40

Percent

Figure 5. Percentage of adults aged 18–64 who were uninsured because coverage was not needed or wanted, by 

selected characteristics: United States, 2019

Fair or poor

Excellent, very good, or good

11.1

323.2

Non-Hispanic black

Non-Hispanic white

Hispanic

18.4

20.9

23.0

50–64

30–49

18–29

17.5

21.2

224.0

Women

Men

14.6

126.8

Total 21.3
NCHS Data Brief ■ No. 382 ■ September 2020

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Summary

In 2019, 14.5% of adults aged 18–64 were uninsured at the time of interview. Among uninsured 

adults aged 18–64, the most common reason for being currently uninsured was because they 

perceived that they could not afford the cost of coverage, followed by not being eligible, not 

wanting coverage, the process of signing up was too difficult or confusing, could not find a plan 

that meets their needs, and they signed up for coverage, but the plan has not started yet. In 2019, 

the percentage of adults who were uninsured due to cost was higher among women, adults aged 

50–64, and adults in fair or poor health. The percentage of adults who were uninsured due to 

ineligibility did not vary by age but was higher among women and adults in fair or poor health. 

In contrast, the percentage of adults who were uninsured because coverage was not needed or 

wanted was higher among men, adults aged 18–29, and adults with excellent, very good, or good 

health. Individuals without health insurance experience barriers to health care such as not having 

a usual source of care and postponing or forgoing care due to cost, which may lead to negative 

health outcomes (2,3).

Definitions

Health status: Adult respondents were asked to assess their health status, specifically, whether 

their “health in general is excellent, very good, good, fair, or poor?”

Race and ethnicity: Categories shown for non-Hispanic respondents are only for those who 

selected one racial group; respondents had the option to select more than one racial group. 

Hispanic respondents might be of any race or combination of races. Only selected groups 

are shown in the individual race and ethnicity bars, but total bars show results for all adults 

aged 18–64.

Reasons for being currently uninsured: “Not affordable,” “Do not need or want,” “Not eligible,” 

“Signing up was too difficult or confusing,” “Cannot find plan that meets needs,” and “Applied 

but has not started” are based on positive responses to a series of questions asking, “Are you 

currently uninsured because ... ‘coverage is not affordable,’ ‘you do not need or want coverage,’ 

‘you are not eligible for coverage,’ ‘the process of signing up for coverage is too difficult or 

confusing,’ ‘you cannot find a plan that meets your needs,’ and ‘you applied for coverage but it 

has not started yet?’”

Uninsured: Adults were considered uninsured if they did not have private health insurance, 

Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), a state-sponsored health 

plan, other government programs, or military health plans (includes TRICARE, VA, and Civilian 

Health and Medical Program of VA [CHAMP-VA]) at the time of interview.
NCHS Data Brief ■ No. 382 ■ September 2020

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Data source and methods

This analysis used data from the Sample Adult component of 2019 National Health Interview 

Survey (NHIS). NHIS is a nationally representative, household survey of the civilian 

noninstitutionalized U.S. population. In 2019, the NHIS questionnaire was redesigned to better 

meet the needs of data users. Additional questions on reasons for being uninsured were added 

to learn more about those who are uninsured. The survey is conducted continuously throughout 

the year by the National Center for Health Statistics (NCHS). Interviews are conducted in the 

respondent’s home, but follow-ups to complete interviews may be conducted by telephone when 

necessary. For more information about NHIS, visit the survey website.

Point estimates and the corresponding variances were calculated using SAS-callable SUDAAN 

version 11.0 (RTI International, Research Triangle Park, N.C.) to account for the complex sample 

design of NHIS. All estimates in this report met NCHS standards of reliability as specified in the 

“National Center for Health Statistics Data Presentation Standards for Proportions” (4). Tests for 

trend were evaluated using orthogonal polynomials in logistic regression. Differences between 

percentages were evaluated using two-sided significance tests at the 0.05 level.

About the authors

Amy E. Cha and Robin A. Cohen are with the National Center for Health Statistics, Division of 

Health Interview Statistics.

References

1. Cohen RA, Terlizzi EP, Martinez ME. Health insurance coverage: Early release of estimates 

from the National Health Interview Survey, 2018. National Center for Health Statistics. 2019. 

Available from: https://www.cdc.gov/nchs/nhis/releases.htm.

2. Freeman JD, Kadiyala S, Bell JF, Martin DP. The causal effect of health insurance on 

utilization and outcomes in adults: A systematic review of U.S. studies. Med Care 46(10):1023–

32. 2008.

3. Tolbert J, Orgera K, Singer N, Damico A. Key facts about the uninsured population. Kaiser 

Family Foundation. 2019. Available from: https://www.kff.org/uninsured/issue-brief/key-factsabout-the-uninsured-population/.

4. Parker JD, Talih M, Malec DJ, Beresovsky B, Carroll M, Gonzalez Jr. JF, et al. National 

Center for Health Statistics data presentation standards for proportions. National Center for 

Health Statistics. Vital Health Stat 2(175). 2017. Available from: https://www.cdc.gov/nchs/data/

series/sr_02/sr02_175.pdf.
NCHS Data Brief ■ No. 382 ■ September 2020

Keywords: health insurance • lack of coverage • National Health Interview 

Survey

Suggested citation

Cha AE, Cohen RA. Reasons for being 

uninsured among adults aged 18–64 in the 

United States, 2019. NCHS Data Brief, no 

382. Hyattsville, MD: National Center for 

Health Statistics. 2020.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Brian C. Moyer, Ph.D., Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate 

Director for Science

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