NBC News reports that Sen. Bernie Sanders has the following response to House Democrats' PAYGO rules:

"At a time when climate change threatens our planet, when our infrastructure is crumbling, when 30 million people have no health insurance, when millions of Americans are struggling with outrageous levels of student debt, I am concerned that the concept of PAYGO will make it harder for Congress to address the many crises facing our working families," Sen. Bernie Sanders, I-Vt., said in a statement on Wednesday.

During the debates over passage of the Affordable Care Act, President Obama and the Democrats claimed that around 20 million people (2008 numbers) were uninsured. According to the media and various researchers, the ACA was indeed successful at adding uninsured Americans to the insurance rolls. Given this, how can Congressional Democrats and those aligned with the Democrats argue that 30 million people are still uninsured? (I realize Sanders is officially independent, but consider him a Democrat for the purposes of this question, as he caucuses with the Senate Democrats and ran for the Democratic presidential nomination.)

I see three possibilities:

  • Sanders and other Democrats making these claims are fabricating the numbers of uninsured for political or other reasons;
  • The Affordable Care Act has not increased the numbers of insured people as is often claimed; or
  • The Trump Administration has made regulatory or other changes that have completely reversed the numbers of insured Americans.

What's the truth? How many uninsured Americans are there?

  • I don't know the answer, but there's a fourth possibility: The number of people grew faster than the number of uninsured. If (as an extreme example) 20 million people represented 10% of the country, but 30 million people only represent 5% of the country, then the absolute numbers go up, even as the percentages go down.
    – Bobson
    Jan 8, 2019 at 0:48
  • @Bobson I thought about adding population dynamics into the question, but decided against it. Population growth couldn't explain both statements being true. The first year that the ACA was in full effect was 2014. The census bureau estimates the US population in July 2014 at ~319M. In July 2018, the estimate is ~329M (source: multpl.com/united-states-population/table).
    – Andrew
    Jan 8, 2019 at 0:54
  • 1
    Oh, I know my examples were way off. The point was more that it depended on what the pool you were counting actually was. As one variant, it could be that the 2008 numbers were based on citizens or registered voters (although I don't know why it would be), but the 2018 numbers are based on all residents, citizen or not. Or it could be the method used to get that estimate is different (they certainly don't know the exact number). Most likely, it's some combination of them all, but in short: "Methodological differences"
    – Bobson
    Jan 8, 2019 at 0:58
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    Somewhat tongue in cheek, the answer is all of them. All (or at least almost all major) medical "insurance" plans in USA aren't actual insurance, despite the applied label. The other side of the political isle agrees too
    – user4012
    Jan 8, 2019 at 1:00
  • I suppose the answer below shows a fifth possiblity: The 2008 numbers were understated (for political or other reasons), rather than the 2018 ones being overstated.
    – Bobson
    Jan 8, 2019 at 19:36

2 Answers 2


How many Americans are uninsured?

According to the Bureau of the Census, in 2016 there were 27.3 million uninsured people in America. This was based on the American Community Survey, which is conducted regularly by the Bureau.

Table S2702 of the 2017 data release (the most recent that appears to be available) says that about 28 million people were uninsured in America that year (see screenshot below): enter image description here

Based on my reading of the survey instrument it reports non-citizens as well as citizens. It seems to capture anyone who lives at a particular address at a particular time.

How about in 2008?

This data table goes back to 2009. The entry for that year says there were about 46 million uninsured people in America that year. That would seem to indicate that the number of uninsured people dropped significantly between 2008 and 2016. enter image description here

  • 1
    I wonder if the uninsured include only those that checked no or the ones that did not answer the question. I did not answer anything other than the count but I am insured and so is the entire household, my mother who is on medicare did not answer at all. Jan 8, 2019 at 13:57
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    @FrankCedeno One of my partners works on survey creation and analysis - the people who make these things are very well educated in how survey answers work and aren't ignorant of the differences between "no answer" and "answering no". They likely use estimates, based on the people who answered, to come up with a most-likely percentage for the non-answers.
    – David Rice
    Jan 8, 2019 at 15:32
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    @FrankCedeno See the section on "item nonresponse" here. For the ACS, they impute data for blank questions. Jan 8, 2019 at 16:14

In 2018 Kevin Drum proposed this graph which shows the percentage of US population uninsured from 2010 to 2018:

enter image description here

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