link to page 1 link to page 2 link to page 2 link to page 2 link to page 1 
Updated March 20, 2024
U.S. Health Care Coverage and Spending
In 2022, the United States had an estimated population of
spending experienced a decline from 2019 to 2020 (Figure
328 million individuals. Most of those individuals had
2), which was predominantly caused by enrollment
private health insurance or were covered under a federal
decreases and lower health care utilization stemming from
program (such as Medicare or Medicaid). About 8.0% of
the Coronavirus Disease 2019 (COVID-19) pandemic, but
the U.S. population was uninsured. Individuals (including
has since rebounded.
those who were uninsured), health insurers, federal and
state governments spent approximately $4.2 trillion on
Medicare
various types of health consumption expenditures (HCE) in
Medicare is a federal health insurance program that pays for
2022, which accounted for 16.5% of the nation’s gross
covered health care services for most people aged 65 and
domestic product.
older and for certain permanently disabled individuals
under the age of 65.
Table 1. Health Care Coverage, 2022
An estimated 61 million individuals (18.5% of the U.S.
Enrollment
population) were enrolled in Medicare in 2022. The
(millions/percentage
program accounted for $944 billion (22.2% of overall
Source
of U.S. population)
HCE); this share is about 10 percentage points higher than
Medicare’s percentage of HCE in 1970 (Figure 2). In 2022,
Insured
302 (92.0%)
most of the spending was for hospital care and physician
Private Health Insurance—Group
180 (54.8%)
and professional services (Figure 1).
Private Health Insurance—Direct-Purchase
46 (13.9%)
Figure 1. Health Consumption Expenditures by Type
Medicaid/CHIP
70 (21.2%)
and Source, 2022
(in bil ions of dol ars)
Medicare
61 (18.5%)
Military—TRICARE
9 (2.7%)
Military—VA Care
7 (2.2%)
Uninsured
26 (8.0%)
Source: U.S. Census Bureau, Table HIC-4_ACS, “Health Insurance
Coverage Status and Type of Coverage by State-Al Persons: 2008 to
2022,” in American Community Survey, September 2023.
Notes: Italicized = does not add to total. Coverage estimates are not
mutual y exclusive. CHIP = State Children’s Health Insurance
Program. Medicaid/CHIP coverage estimate includes al means-tested
Source: Centers for Medicare & Medicaid Services (CMS), National
public coverage (e.g., state and local y financed public coverage).
Health Expenditure Accounts—National Health Expenditures by
Private Health Insurance
Type of Expenditure and Program, December 2023.
Private health insurance is the predominant source of health
Notes: Al the terms used in this figure are defined in the source
insurance coverage in the United States. Private health
document, except long-term services and supports, which is defined
insurance includes both group coverage (largely made up of
here in the Medicaid/CHIP section. CHIP = State Children’s Health
employer-sponsored insurance) and direct-purchase
Insurance Program; DME = durable medical equipment.
coverage (which includes plans directly purchased from an
insurer both on the health insurance exchanges and outside
Medicaid/CHIP
of them). In 2022, an estimated 180 million individuals
Medicaid is a joint federal-state program that finances the
(54.8% of the U.S. population) and 46 million individuals
delivery of primary and acute medical services, as well as
(13.9% of the U.S. population) were covered by group
long-term services and supports, to a diverse low-income
coverage and direct-purchase coverage, respectively.
population, including children, pregnant women, adults,
individuals with disabilities, and people aged 65 and older.
In 2022, private health insurance expenditures accounted
The State Children’s Health Insurance Program (CHIP) is a
for $1,290 billion (30.4% of overall HCE). Private health
means-tested program that provides health coverage to
insurance expenditures include amounts paid by insuring
organizations to providers and all insuring organizations’
targeted low-income children and pregnant women in
families that have annual income above Medicaid eligibility
nonmedical net costs, which include but are not limited to
levels but have no health insurance.
taxes, net gains or losses to reserves, and profits. A majority
of this spending was for hospital care and physician and
An estimated 70 million individuals (21.2% of the U.S.
professional services (Figure 1). Private health insurance
population) received Medicaid or CHIP in 2022, and the
https://crsreports.congress.gov
link to page 2 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
programs accounted for $829 billion (19.5% of overall
individuals for coinsurance, deductibles, and services not
HCE). This spending is about 12 percentage points higher
covered by insurance. It also includes amounts paid by the
than Medicaid/CHIP’s percentage of total HCE in 1970
uninsured for health care goods and services. Among all
(Figure 2). Furthermore, relative to other coverage,
individuals, out-of-pocket spending was $471 billion
Medicaid spends the highest percentage of its expenditures
(11.1% of total HCE) in 2022, with roughly 30%
on long-term services and supports, which include (1) other
attributable to durable medical equipment and other non-
health, residential, and personal care; (2) nursing care
durable medical products.
facilities and continuing care retirement communities; and
(3) home health care (Figure 1).
The Uninsured
Approximately 26 million individuals (8.0% of the U.S.
Figure 2. Health Consumption Expenditures (HCE) by
population) were uninsured in 2022. Historically, the
Source as a Percentage of Total HCE, 1961-2022
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 direct-purchase 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, premium tax credit, and Medicaid expansion.
Since 2016, the uninsured rate slowly increased to 9.2% in
2019 before falling to 8.0% in 2022. This decline
corresponds with increases in direct-purchase and
Medicaid/CHIP coverage, which were impacted by policies
enacted in response to the COVID-19 pandemic.
Source: CMS, National Health Expenditure Accounts—National
Health Expenditures by Type of Service and Source of Funds,
Figure 3. Health Insurance Coverage as a Percentage
CY1960-2022, December 2023.
of Total U.S. Population, 2008-2022
Notes: CHIP = State Children’s Health Insurance Program.
Military
Health care services for military servicemembers, veterans,
and their dependents are provided by the Department of
Defense, through programs such as TRICARE, and the
Department of Veterans Affairs. In 2022, an estimated
9 million individuals (2.7% of the U.S. population) had
TRICARE and 7 million (2.2% of the U.S. population)
individuals had VA Care. Together, these departments
accounted for $148 billion (3.5% of total HCE).
Other Health Services
Source: U.S. Census Bureau, Table HIC-4_ACS, “Health Insurance
Other health care spending covers services provided
Coverage Status and Type of Coverage by State-Al Persons: 2008 to
through public and private programs not listed above,
2022,” in American Community Survey, September 2023.
including worksite health care programs, philanthropic
Notes: Estimates not available for 2020. Coverage estimates are not
support, Indian Health Service activities, workers’
mutual y exclusive. CHIP = State Children’s Health Insurance
compensation, general assistance, the Maternal and Child
Program. Medicaid/CHIP coverage estimate includes al means-tested
Health program, vocational rehabilitation, Substance Abuse
public coverage, such as state and local y financed public coverage.
and Mental Health Services Administration grants, federal
and state public health activities, school health programs,
The cost of care for the uninsured population is accounted
and other programs whose primary focus is the provision of
for in multiple spending categories (Figure 1 and Figure
care or treatment of disease. Other health services saw a
2). Payments made by uninsured individuals for health care
sharp, temporary increase in spending in 2020 to $752
services are included in the out-of-pocket total. Any
billion (19.0% of total HCE) (Figure 2). This increase was
amounts received by providers that help to partially and/or
primarily due to federal health spending addressing the
indirectly cover the cost of care for the uninsured are
COVID-19 pandemic, such as Paycheck Protection
accounted for in corresponding source totals (e.g., Medicare
Program loans, Provider Relief Fund payments, and public
and Medicaid disproportionate share hospital payments are
health activities. Federal spending addressing COVID-19
included in program totals).
continued to decline in 2022, which contributed to the
decline in other health care spending to $564 billion (13.3%
For more information about federal health programs, see
of total HCE).
the CRS Health Care issue area page at http://www.crs.gov/
iap/health-care.
Out-of-Pocket Spending
Out-of-pocket spending (other than premiums) includes all
Ryan J. Rosso, Analyst in Health Care Financing
amounts paid by the privately insured and other insured
IF10830
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 14 · UPDATED