Uninsured adults are disproportionately poor, young, Latino, and employed by small businesses, according to a Commonwealth Fund survey. Since the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) went into effect, the number of uninsured individuals has fallen to historic lows—an estimated reduction of 20 million individuals. However, 24 million individuals still lack coverage. The Commonwealth Fund conducted the survey to ascertain the makeup of those remaining uninsured individuals and to determine why they are not insured.
Demographics. Among the groups that were most at risk of being uninsured prior to the ACA, the same groups continue to have lower rates of insurance than their demographic counterparts. As a result, uninsured adults are disproportionately poor, young, Latino, and employed by small businesses that do not provide coverage. One of the most significant shifts in the makeup of the uninsured population is among Latinos. While Latinos accounted for 29 percent of the uninsured population in 2013, in 2016 Latinos represent 40 percent of the uninsured population. In comparison to other demographic groups, at the same time, the percentage of uninsured whites declined, falling from 50 percent in 2013 to 41 percent in 2016.
Cost. Individuals without insurance continue to be very poor—39 percent of the uninsured have incomes below the federal poverty level. Among uninsured individuals who have tried to enroll or are aware of the ACA marketplaces, the majority of those individuals cite the cost of coverage as a reason for not signing up for plan. However, 94 percent of uninsured individuals have incomes under 400 percent of poverty—$47,080 for an individual and $97,000 for a family of four— incomes that establish income-eligibility for marketplace subsidies or Medicaid.
Contributing factors. The Commonwealth Fund pointed to the following six factors as the primary drivers behind the fact that 24 million individuals remain uninsured: (1) the ACA’s exclusion of undocumented immigrants from the coverage expansions; (2) the refusal of 19 states to expand Medicaid; (3) limited awareness about the ACA’s marketplaces among certain demographic groups; (4) concerns about plan affordability and eligibility for subsidies; (5) difficulty selecting plans during the enrollment process; and (6) a lack of assistance in selecting plans.
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