Dear reader,
We are back after last week’s break. Over the past month, we’ve been looking into measures that reflect the reverse of violence. In our last edition, we looked at the theme of opportunity through the lens of the nation’s rising high school graduation rates. This week, we explore another theme: care.
Many of those who responded to our questions about the forces that restrain and oppose violence gave answers that related to care and healing. “The opposite of violence has to proactively repair what was damaged, then perhaps go farther,” wrote one respondent. “In the end, love conquers hate,” wrote another, “but love must be demonstrated by overt acts of kindness and caring, healing the wounds and making the community healthy.”
In the course of our reporting on violence prevention, the role of the health care system has been a recurring factor. Hospital-based interventions can play a critical role in interrupting cycles of violence, whether by reducing the lethality of shootings, connecting victims with support services or identifying and addressing untreated trauma. Access to health care isn’t a perfect proxy for the presence of care and healing in a community, but it does play a role in whether violence spreads or diminishes.
So read on for a briefing from Ama Sarpomaa on how the United States is doing when it comes to providing coverage for health care. For much of the time violent crime in the U.S. has been declining, the share of people without insurance has, too. But that’s changing.
— Matthew Thompson
How many people are uninsured?
The percentage of uninsured Americans has nearly halved since 2010. It dropped from 16 percent to 8.2 percent in 2024. But it’s once again on the rise.
Experts credit much of the initial decline to the passage of the Affordable Care Act, or Obamacare, in 2010, followed by the implementation of Medicaid expansions in 2014 and the launch of the A.C.A. marketplaces in late 2013.
Congressional Republicans and moderate Democrats repeatedly sought to quell the health insurance reform, both before and after its enactment. Anti-A.C.A. protesters and lawmakers denounced it as a form of socialism, and the G.O.P. made several attempts to repeal it, most notably with three amendment proposals in 2017. But support for the A.C.A. among American adults in both parties grew steadily after its passage.
The early 2000s was a grim time for purchasing health care coverage, particularly for racial and ethnic minorities. Premiums were rising fast: Between 2000 and 2004, they increased by 59 percent. The number of uninsured Americans increased by 1.4 million in one year. According to an Urban Institute analysis, over 130,000 uninsured people died prematurely from 2000 through 2006.
Rising costs meant fewer insurers offered coverage, which left people without employer-based plans to purchase individual policies. Insurance companies were also retroactively canceling plans, denying coverage to patients with medical problems and rescinding policies for patients who required costly treatments.
The A.C.A. introduced new, regulated health insurance markets and penalized large employers who failed to provide affordable coverage to employees. The law limited how insurance providers could treat patients with pre-existing health conditions, who could no longer be denied coverage or charged higher premiums, or have their policies rescinded. Insurers could also no longer impose lifetime limits on the costs of care.
Before the A.C.A., people of color under 65 were more likely to be uninsured than their white counterparts. Latoya Hill, a senior policy manager at KFF, a health research organization that tracked the decline in uninsured rates, said that this disparity had persisted but had significantly narrowed under the A.C.A. In just two years, for example, the rate of uninsured Latinos fell from almost 33 percent in 2014 to about 19 percent in 2016, as subsidies expanded access.
New policies that made it harder to get and keep Medicaid coverage led to a three-year rise in uninsured rates until 2019. Then, after declining for several years, the number of uninsured Americans rose again in 2023.
What’s changing?
The health insurance landscape has changed significantly in just a few years:
Medicaid disenrollment: Medicaid coverage expanded during the pandemic, but many states began disenrolling millions of Medicaid enrollees in 2023, which KFF believes may have contributed to the rise in uninsured rates.
Sweeping legislation: In July 2025, President Trump signed into law the budget reconciliation bill known as the One Big Beautiful Bill Act. The bill included significant health care policy changes, such as checking people’s eligibility more often and restricting sign-ups to special enrollment periods.
Subsidy expiration: The A.C.A.’s enhanced premium tax credits, which were introduced in 2021 and temporarily extended through 2025, broadened the subsidies to cover Americans earning more than $62,600. Those extra subsidies expired on Jan. 1 this year, the issue that caused last year’s monthslong government shutdown. In November, Trump signed into law a spending bill that passed the Senate and the House without the extensions. Now, many Americans are facing a huge subsidy cliff, which could more than double premiums.
Medicaid expansion and the coverage gap: A disproportionate share of people of color fall into the coverage gap in states without Medicaid expansion. Some adults in that gap have incomes either too high to qualify for Medicaid or too low to qualify for A.C.A. subsidies. KFF found that a majority of Americans in the coverage gap live in Southern states that have not adopted Medicaid expansion.
What might happen from here?
Health care costs continue to balloon. Prior authorization requirements and other moves from insurance companies have made timely treatment less attainable. Some Medicare recipients’ monthly expenses have already increased almost 10 percent.
“There are certain procedures that are simply not going to be possible for certain families if they don’t have access to health insurance,” said Kyle Moore, an economist at the Economic Policy Institute. Some low-income families, he said, forgo preventive care to afford basic necessities. Without preventive care, cancers and other life threatening diseases are harder to catch early.
But affording rising health care costs is challenging, even for people with health insurance. A survey conducted by the West Health-Gallup Center on Healthcare in America estimates that one in three American adults sacrifice meals and borrow money to pay for health care. Some reported postponing major life events like buying a new home.
Those without insurance report making even more sacrifices to keep up with costs. Unaffordable medical bills are particularly perilous for uninsured adults, who are more susceptible to medical debt, which is one of the main causes of personal bankruptcy in the country.
Americans generally spend more for health care than their global peers do, despite the fact that the U.S. has fewer hospital beds and fewer physicians per capita than other wealthy nations.
Unaffordable health care costs, coupled with increasing health insurance premium costs, could worsen the nation’s uninsured rates. The Congressional Budget Office projects that the uninsured rate will increase by 10 million in 2034, mainly because of the changes to Medicaid, A.C.A. marketplaces and other policies.
Even though 2025 data is still unavailable, Ms. Hill said, we are already seeing notable declines in A.C.A. marketplace and Medicaid enrollment, which could be an early indication of emerging coverage losses.
Higher premiums restructure the economics of health care for everyone — healthy adults are more likely to opt out of insurance as premiums get increasingly less affordable, leaving sicker individuals who rely more on health insurance to bear the weight of higher premiums.
“It could be at a tipping point where it just gets worse and worse,” said Dr. Gerard Anderson, a professor in health policy and management at Johns Hopkins University.
What can I check out next?
— Ama Sarpomaa
Your turn
Test your knowledge: As the nation’s population has aged and more Americans have gotten access to insurance, the share of the U.S. workforce in the health and social assistance sector has grown from 8.3 percent of total employment in 1990 to what percent today?
Tell us your thoughts: How has access to health insurance — or the lack of it — shaped your experience and the community around you? Do you see a connection between health care coverage and rates of violence? Please email your thoughts to [email protected].
Following up: While our last newsletter focused on the recent rise in high school graduation rates, the view is looking very different higher up the education ladder. This week brings news that fall admissions to Ph.D programs at over 50 top U.S. research institutions have dropped by 15 percent in a year. That’s after a fall 2025 survey of 42 schools showed an 11 percent decline in new enrollments.
Ama Sarpomaa contributed reporting.
The Headway initiative is funded through grants from the Ford Foundation, the William and Flora Hewlett Foundation and the Stavros Niarchos Foundation (SNF), with Rockefeller Philanthropy Advisors serving as a fiscal sponsor. The Woodcock Foundation is a funder of Headway’s public square. Funders have no control over the selection, focus of stories or the editing process and do not review stories before publication. The Times retains full editorial control of the Headway initiative.