People without access to coverage through their employer are at great risk of being uninsured, since there are few affordable coverage health insurance options outside of the employer group market. Indeed, most people who are uninsured are members of working families. About two of five Americans, insured and uninsured alike, have trouble paying their medical bills or have racked up medical debts.

It seems that while many people remain without health insurance for long periods of time, others cycle in and out of coverage. People with gaps in health insurance coverage are as likely to experience health care access problems and difficulty paying medical bills as those who are continuously uninsured. All this churning and changing helps to drive up the costs of administering private and public health insurance programs and undermines efforts to provide effective care. Policymakers and researchers continue to develop innovative strategies for expanding and improving health coverage.

Some new approaches include:
Expanding eligibility or allowing people to buy-in to existing federal and state public health insurance programs;
Expanding private group coverage through employers or federal or state employee health insurance programs;
Establishing tax credits or other subsidies for individuals and employers to defray the cost of health insurance; and
Using reinsurance to lower the cost of coverage for employers.