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The researchers note that other factors such as health status and the complexity of the market can also affect the purchase of individual health insurance, but conclude that they are unlikely to be the primary drivers of low coverage rates. [14] Many states allow medical underwriting of applicants for individually purchased health insurance.
Private health insurance may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. Most Americans with private health insurance receive it through an employer-sponsored program.
The primary reason for the 6.5 million (24%) increase in uninsured from 2016 to 2029 is the repeal of the ACA individual mandate to have health insurance, enacted as part of the Trump tax cuts, with people not obtaining comprehensive insurance in the absence of a mandate or due to higher insurance costs.
In 2024, of the 21.6 million Americans who purchased health insurance plans from ACA marketplaces, 20.1 million received enhanced subsidies, according to the CBO.
The health insurance advocacy group America's Health Insurance Plans was willing to accept these constraints on pricing, capping, and enrollment because of the individual mandate: The individual mandate requires that all individuals purchase health insurance.
For a family, the average health insurance premium cost $25,572 in 2024, combining employer and family contributions, according to KFF. Premiums have increased by half since 2014.