link to page 1 link to page 2 link to page 2 link to page 1 
Updated April 1, 2022
U.S. Health Care Coverage and Spending
In 2020, the United States had an estimated population of
organizations to providers and all insuring organizations’
326 million individuals. Most of those individuals had
nonmedical net costs, which include, but are not limited to,
private health insurance or received health care services
taxes, net gains or losses to reserves, and profits. A majority
under a federal program (such as Medicare or Medicaid).
of this spending was for hospital care and physician and
About 8.6% of the U.S. population was uninsured.
professional services (Figure 1). Private health insurance
Individuals (including those who were uninsured), health
spending experienced a decline in 2020 (Figure 2). This
insurers, and federal and state governments spent
decline was predominantly caused by enrollment decreases
approximately $3.9 trillion on various types of health
and lower health care utilization stemming from the
consumption expenditures (HCE) in 2020, which accounted
Coronavirus Disease 2019 (COVID-19) pandemic.
for 18.8% of the nation’s gross domestic product.
Medicare
Table 1. Health Care Coverage, 2020
Medicare is a federal health insurance program that pays for
covered health care services for most people aged 65 and
Enrollment
older and for certain permanently disabled individuals
(millions/percentage
under the age of 65.
Source
of U.S. population)
Insured
298 (91.4%)
An estimated 60 million individuals (18.4% of the U.S.
population) were enrolled in Medicare in 2020. The
Private health insurance – Group
177 (54.4%)
program accounted for $829 billion (21.1% of overall
HCE); this share is about 10 percentage points higher than
Private health insurance – Non-group
34 (10.5%)
Medicare’s percentage of HCE in 1970 (Figure 2). In 2020,
Medicare
60 (18.4%)
most of the spending was for hospital care and physician
and professional services (Figure 1).
Medicaid/CHIP
58 (17.8%)
Military - TRICARE
9 (2.8%)
Figure 1. Health Consumption Expenditures by Type
and Source, 2020
Military - VA Care
3 (0.9%)
(in bil ions of dol ars)
Uninsured
28 (8.6%)
Source: U.S. Census Bureau, Table HHI-02, “Health Insurance
Coverage Status and Type of Coverage—Al Persons by Age and Sex:
2017 to 2020,” in Current Population Survey Annual Social and Economic
Supplement, October 2021.
Notes: Italicized = does not add to total. Estimates by type of
coverage are not mutual y exclusive. CHIP = State Children’s Health
Insurance Program. Medicaid/CHIP coverage estimate also includes al
means-tested public coverage (e.g., state and local y financed public
coverage). The U.S. Census Bureau American Community Survey has
historical y been used for estimates in this table, but such estimates
are not available for 2020.
Source: Centers for Medicare and Medicaid Services, National
Private Health Insurance
Health Expenditure Accounts—National Health Expenditures by
Private health insurance is the predominant source of health
Type of Expenditure and Program, December 2021.
insurance coverage in the United States. The private health
Notes: Al of the terms used in this figure are defined in the source
insurance market includes both the group market (largely
document, except long-term services and supports, which is defined
made up of employer-sponsored insurance) and the non-
in the text of this In Focus. CHIP = State Children’s Health Insurance
group market (commonly referred to as the individual
Program; DME = durable medical equipment.
market, which includes plans directly purchased from an
insurer both on and off health insurance exchanges). In
Medicaid/CHIP
2020, these markets covered an estimated 177 million
Medicaid is a joint federal-state program that finances the
individuals (54.4% of the U.S. population) and 34 million
delivery of primary and acute medical services, as well as
individuals (10.5% of the U.S. population), respectively.
long-term services and supports, to a diverse low-income
population, including children, pregnant women, adults,
In 2020, private health insurance expenditures accounted
individuals with disabilities, and people aged 65 and older.
for $1,151 billion (29.3% of overall HCE). Private health
The State Children’s Health Insurance Program (CHIP) is a
insurance expenditures include amounts paid by insuring
means-tested program that provides health coverage to
https://crsreports.congress.gov
link to page 2 link to page 1 link to page 1 link to page 2 link to page 2 link to page 1 link to page 2 link to page 2 
U.S. Health Care Coverage and Spending
targeted low-income children and pregnant women in
Out-of-Pocket Spending
families that have annual income above Medicaid eligibility
Out-of-pocket spending (other than premiums) includes all
levels but have no health insurance.
amounts paid by the privately insured and other insured
individuals for coinsurance, deductibles, and services not
Figure 2. Health Consumption Expenditures (HCE) by
covered by insurance. It also includes any amounts paid by
Source as a Percentage of Total HCE, 1960-2020
the uninsured for health care goods and services. Among all
individuals, out-of-pocket spending totaled $389 billion
(9.9% of total HCE) in 2020.
The Uninsured
Approximately 28 million individuals (8.6% of the U.S.
population) were uninsured in 2020. The uninsured rate was
relatively stable from 2008 to 2013 before dropping 6
percentage points by 2016 to 8.6% (Figure 3). This drop in
the uninsured rate corresponds with increases in non-group
coverage and Medicaid/CHIP coverage, which are
associated with the implementation of various provisions of
the Patient Protection and Affordable Care Act (ACA; P.L.
111-148, as amended), such as the exchanges and premium
Source: Centers for Medicare and Medicaid Services, National
tax credits and the Medicaid expansion. The uninsured rate
Health Expenditure Accounts—National Health Expenditures by
slowly increased from 2016 to 2019.
Type of Service and Source of Funds, CY1960-2020, December 2021.
Notes: CHIP = State Children’s Health Insurance Program.
Figure 3. Health Insurance Coverage by Source as a
Percentage of Total U.S. Population, 2008-2019
An estimated 58 million individuals (17.8% of the U.S.
population) received Medicaid or CHIP in 2020, and the
programs accounted for $693 billion (17.6% of overall
HCE). This spending is about 10 percentage points higher
than Medicaid/CHIP’s percentage of total HCE in 1970
(Figure 2). Furthermore, Medicaid spends the highest
percentage of its expenditures on long-term services and
supports, which include (1) other health, residential, and
personal care; (2) nursing care facilities and continuing care
retirement communities; and (3) home health care (Figure
1). Long-term services and supports also include some post-
acute care (i.e., skilled care provided over a short term,
typically after a hospitalization).
Military
Source: U.S. Census Bureau, Table HIC-4_ACS, “Health Insurance
Coverage Status and Type of Coverage by State-Al Persons: 2008 to
Health care services for military servicemembers, veterans,
2019,” in American Community Survey, September 2020.
and their dependents are provided by the Department of
Notes: Estimates by type of coverage are not mutual y exclusive.
Defense, through programs such as TRICARE, and the
CHIP = State Children’s Health Insurance Program. Medicaid/CHIP
Department of Veterans Affairs. In 2020, an estimated
coverage estimate also includes al means-tested public coverage,
9 million individuals (2.8% of the U.S. population) had
such as state and local y financed public coverage.
TRICARE and 3 million (0.9% of the U.S. population)
individuals had VA Care. Together, these departments
The cost of care for the uninsured population is accounted
accounted for $136 billion (3.5%) of total HCE.
for in multiple spending categories (Figure 1 and Figure
Other Health Services
2). Payments made by uninsured individuals for health care
services are included in the out-of-pocket total. Any
Other health care spending covers services provided
amounts received by providers that help to partially and/or
through public and private programs not listed above,
indirectly cover the cost of care for the uninsured are
including worksite health care programs, philanthropic
accounted for in corresponding source totals (e.g., Medicare
support, Indian Health Service activities, workers’
and Medicaid disproportionate share hospital payments are
compensation, general assistance, the Maternal and Child
included in program totals).
Health program, vocational rehabilitation, Substance Abuse
and Mental Health Services Administration grants, federal
For more information about federal health programs, see
and state public health activities, school health programs,
the CRS Health Care issue area page at http://www.crs.gov/
and other programs whose primary focus is the provision of
iap/health-care.
care or treatment of disease. Other health services saw a
sharp increase in spending in 2020 to $733 billion (18.7%
of total HCE) (Figure 2). This increase was primarily due
Ryan J. Rosso, Analyst in Health Care Financing
to federal health spending addressing the COVID-19
IF10830
pandemic, such as Paycheck Protection Program loans,
Provider Relief Fund payments, and public health activities.
https://crsreports.congress.gov
U.S. Health Care Coverage and Spending
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you
wish to copy or otherwise use copyrighted material.
https://crsreports.congress.gov | IF10830 · VERSION 10 · UPDATED