In 2024, 27.2 million Americans lacked health insurance, down from 31.6 million in 2020. Although the federal individual mandate penalty was repealed in 2019, some states still impose fines for being uninsured. States with penalties include California, D.C., New Jersey, Massachusetts, and Rhode Island, with fines based on income or fixed amounts. Exemptions exist for financial hardship, high costs, short coverage gaps, or low income. State subsidies may help reduce insurance costs.