Over 20 million Americans lack health insurance. Democrats are betting that public concern over that number will propel them back into power this fall.
But the headline figure obscures a more important question. Why do so many people go without coverage?
A new report from the Centers for Disease Control and Prevention sheds light on that question. Cost is certainly a factor. But it’s not the whole story.
Just 20% of uninsured Americans went without coverage for cost reasons alone. Another 4 in 10 cited affordability alongside other factors.
On the flip side, one-third of uninsured people said affordability wasn’t the issue at all. Within this group, 44% said they didn’t want or need coverage. Twelve percent said they could not find a plan that met their needs.
In other words, for millions of people, price alone isn’t the problem. The available options aren’t worth buying.
Addressing those concerns will require rolling back some of Obamacare’s mandates.
Exchange plans often come with narrow provider networks and high deductibles. Patients may struggle to find doctors and hospitals, especially top-tier providers, that accept their coverage. Federal rules also require every plan to cover a standardized set of 10 “essential” health benefits, regardless of whether enrollees want or need them.
For many consumers, especially younger, healthier ones, those trade-offs aren’t appealing. Some opt out entirely.
If policymakers want to reduce the number of uninsured Americans, they should focus on expanding choice rather than piling on more subsidies or mandates.
One option is to broaden access to short-term health plans, which are exempt from many of Obamacare’s mandates. These plans tend to offer lower premiums, more flexible benefit designs, and broader provider networks. Exchange plans frequently keep costs down by restricting access to doctors and hospitals. Short-term plans don’t face the same constraints. That can make them a better fit for consumers who want real choice in where they receive care.
During its first term, the Trump administration enacted rules that allowed short-term plans to last for up to a year and to be renewed for up to three years. The Biden administration rolled back those rules and set the limit at three months, with an option for a one-month renewal. The Biden-era rules remain in effect today.
Lawmakers could also expand access to health savings accounts, which allow people to set aside funds tax-free for medical expenses. Pairing an HSA with a lower-cost insurance option — or even a fixed-indemnity plan that pays a set amount for certain medical services — could better meet the needs of people who feel poorly served by today’s one-size-fits-all system.
CONGRESS IS ABOUT TO UNDO DOGE’S BIGGEST WIN
The goal shouldn’t just be to get people insured. It should be to offer coverage people actually want to buy — as they do when choosing most other goods and services.
Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy—and How to Keep It (Encounter 2025). Follow her on X @sallypipes.