Publication Date



Health insurance is an important resource for enabling access to and use of medical care, and is associated with reduced risk for mortality and poor health outcomes. Health insurance also protects households from incurring major medical expenses and unmanageable levels of medical debt. About a quarter of a sample of low- and moderate-income (LMI) tax filers have no health insurance, compared to 10% of all individuals in the United States. As of 2014, the proportion of filers without insurance was 11 percentage points higher in states that had not expanded Medicaid through the Affordable Care Act (ACA) than it was in expansion states. Lack of insurance is associated with lower income and assets, and higher unsecured debt, as well as greater likelihood of experiencing financial difficulties and material hardship. Despite progress in expanding health insurance coverage under the ACA, additional efforts are needed, including effort to further expand Medicaid and high-risk insurance pools, strengthen charity care policies and practices, and forgive medical debt.

Document Type

Research Brief


Financial Inclusion


Financial Behaviors

Original Citation

Despard, M. R., Roll, S. P., Perantie, D. C., Oliphant, J. E., & Grinstein-Weiss, M. (2016, July). The role of health insurance in the financial lives of low- and moderate-income households (CSD Research Brief No. 16-26). St. Louis, MO: Washington University, Center for Social Development.


Refund to Savings (R2S)


debt, Earned Income Tax Credit (EITC), health insurance, Household Financial Survey (HFS), material hardship, TurboTax Freedom Edition, Medicaid, Patient Protection and Affordable Care Act of