Like other immigrants to the U.S., Asian immigrants overwhelmingly say they emigrated for the opportunity to build a better life for themselves and their children. They come from more than 30 countries, and their experiences – their economic circumstance, how safe they feel, and the discrimination they face – vary greatly once here, including differences by income level, immigration status and country of origin.

These three charts explore the diversity of the Asian immigrant experience, drawing on findings from a new KFF report based on data from the KFF-Los Angeles Times Survey of immigrants:

1) Most Asian immigrants are faring relatively well financially, though there’s variation by region of origin, with immigrants from South Asia doing notably better than those from East or Southeast Asia. And one-in-three low-income Asian immigrants struggle to pay their bills.

2) One-in-six Asian immigrants, including one-in-three of those born in China, say they feel less safe due to their move to the United States. One-in-five Asian immigrants – and a higher share of those from China – also say that the COVID-19 pandemic has negatively impacted how they are treated in the United States, likely reflecting anti-Chinese rhetoric amidst the pandemic.

3) One-in-five Asian immigrants who sought health care in the U.S. say they have been treated unfairly by a health care provider at some point due to their accent or ability to speak English, their racial or ethnic background or skin color, or their ability to pay. The shares are higher among those with lower incomes or limited English proficiency.

For more about Asian immigrants’ experiences beyond these three charts, including their reasons for coming, their employment and financial situation, their experiences with discrimination and health care, and their understanding of immigration policies, read our new report, “Understanding the Diversity in the Asian Immigrant Experience in the U.S.: The 2023 KFF/LA Times Survey of Immigrants.”

In September 2023, the National Institutes of Health designated people with disabilities as a population experiencing health disparities, which will help ensure that people with disabilities are represented in research funded by the National Institutes. Also in September of 2023, the Biden Administration proposed a new rule that would update the requirements for nondiscrimination on the basis of disability. Among other changes, the proposed rule would codify the Olmstead court decision, which requires people with disabilities to be served in the most integrated setting that is appropriate. The new designation and proposed rule may reflect, in part, an increased awareness of the challenges and health disparities faced by people with disabilities, many of which were exacerbated by the COVID-19 pandemic and its aftermath.

In this analysis, KFF examines the characteristics of people with disabilities who are living in the community from the American Community Survey. State-level data are also available on State Health Facts.

Key takeaways include: 

• Over one in ten (11%) working-age adults ages 18-64 living in the community reported having a disability on the 2022 American Community Survey, which is defined as having a difficulty with hearing, vision, cognition, ambulation, self-care, or independent living.
• Those 21.8 million working-age adults report difficulties with a range of different activities and are lower-income than working-age adults who did not report a disability.
• Adults with disabilities are over twice as likely to have Medicaid as adults without disabilities, but fewer than a third receive income from the social security disability programs.

1. What are the demographic characteristics of working-age adults with disabilities?

People with disabilities tend to be older than other working-age adults, but the racial and gender distributions of people with disabilities are like those of people without disabilities (Figure 1). Nearly half (47%) of working-age adults with a disability are 50 years old or older, compared with only 30% of working-age adults without a disability. Smaller percentages of people with disabilities are ages 18-29, 30-39, and 40-49 than among adults without disabilities. Although the racial and ethnic distributions of working-age adults are similar for people with and without disabilities, among people with disabilities a smaller percent are Hispanic (17% compared to 20%) and Asian (3% compared to 7%), and a larger percent are Black (15% compared to 12%). Among working-age adults, roughly half are female regardless of disability status.

2. What types of difficulties do working-age adults with disabilities report?

Among adults ages 18-64 with a disability, nearly half report a cognitive difficulty and nearly half report having more than one difficulty (Figure 2). Of the 21.8 million adults ages 18-64 who report having a disability, nearly half report difficulties with cognition, which is defined as difficulty concentrating, remembering, or making decisions; over two-fifths report difficulties with ambulation (defined as difficulty with walking or climbing stairs); and over a third report difficulties living independently (defined as difficulty doing errands alone such as visiting a doctor’s office or shopping). Fewer working-age adults report difficulties seeing, hearing, and with self-care (defined as difficult dressing or bathing). Among working-age adults with a disability, 44% report having more than one difficulty, with 9% reporting four or more difficulties.

3. What is the income and employment status of working-age adults with disabilities?

Working-age adults with disabilities are almost twice as likely to have income below 200% Federal Poverty Level (FPL) compared with adults without disabilities (Figure 3). The income distribution of working-age adults with disabilities is lower than that of working-age adults without disabilities. One in four working-age adults with a disability have incomes below FPL ($14,880 for an individual, and $23,280 for a family of three on average in 2022). Income is generally higher for working-age adults without disabilities with only 10% reporting incomes below FPL and almost half having incomes above 400% FPL.

The percentage of working-age adults with disabilities who do not work is over three times greater than the percentage of working-age adults without disabilities who do not work (Figure 4). Lower income is likely related to lower levels of employment among working-age adults with disabilities: Almost half of people with disabilities do not work and one third work full time (35 or more hours per week). In comparison, over 64% of adults without a disability work full time and 16% do not work at all.

4. How do working-age adults with disabilities access health insurance coverage?

The percentage of people with Medicaid is over two times higher among working-age adults with disabilities compared with those without disabilities (Figure 5). Among working-age adults with disabilities, 38% have Medicaid, which includes 30% who have Medicaid only and an additional 8% who have Medicaid and Medicare (dual-eligible individuals). Among those without a disability, 13% have Medicaid and 1% have Medicare and Medicaid. Notably, the majority of Medicaid enrollees with disabilities qualify on the basis of low income rather than on the basis of disability. The Medicaid expansion under the Affordable Care Act (ACA) – which all but 10 states have taken up – is based only on income. Qualifying for Medicaid based on disability status generally involves a complex application process to determine the extent of the disability and typically includes an asset test. To be eligible for Medicare, people must generally be ages 65 and older, or have a disability that qualifies them for the federal disability insurance program (DI). For most people ages 64 and younger, Medicare coverage begins only after waiting a 2-year waiting period which starts after they have been approved for DI benefits. As a result, 8% of working-age adults with disabilities have Medicare as their only source of coverage compared with only 1% of adults without a disability. 

All other coverage—including coverage through an employer, direct purchase, VA—accounts for 41% among working-age adults with disabilities compared with 74% of those without disabilities. Rates of employer coverage are nearly twice as high among adults without disabilities compared to those with (64% to 33% respectively). Uninsured rates are similar among working-age adults with and without a disability (10% and 11% respectively).

5. How many adults with disabilities receive income from the social security disability programs?

Fewer than a third of working-age adults with disabilities receive any income from the social security programs, including Social Security Disability Insurance (DI) and Supplemental Security Income (SSI). Social security income includes income from several programs that support people who are retired, have qualifying disabilities, are survivors of people who died and had paid into the system, or who have limited financial resources and either a qualifying disability or are age 65 and older. The two primary programs include SSI and DI: 

• SSI is a federal program administered by the Social Security Administration (SSA) that ensures a minimum level of income for poor people who are elderly or disabled. To qualify, SSI enrollees must have low income, limited assets, and either be age 65 or older or have an impaired ability to work at a substantial gainful level according to strict federal rules. Unlike DI, SSI is available to people regardless of their work history. As a result of strict SSA disability determination rules, not all people with disabilities qualify for SSI.
• DI is a separate program from SSI also administered by the SSA. Unlike SSI, there are no income or asset limits for DI eligibility. Instead, to qualify for DI, enrollees must have a sufficient work history (generally, 40 quarters) and meet the strict federal disability rules. The amount of DI benefits is based on the person’s earnings history.

People receive both DI and SSI when their incomes (including DI benefits) are less than the maximum SSI payments. Among working-age adults with disabilities, fewer than one-third receive social security income: (14% receive DI, 12% receive SSI, and 3% receive benefits from both programs) (Figure 6).

Looking Ahead, what are key issues to watch?

What new challenges will emerge now that the COVID-19 public health emergency has ended? Working-age adults with disabilities are a heterogenous group that may be facing unique challenges as the nation emerges from the COVID-19 public health emergency. These challenges include higher rates of long COVID than among people without disabilities, and disruptions in access to ongoing services and supports including telehealth services and Medicaid home- and community-based services. Recognizing the importance of home- and community-based services (HCBS) for people with disabilities during the pandemic and the workforce shortages during that time, the federal government provided new funding and flexibilities for states when delivering HCBS. In many states, those policies are ending which may create additional barriers to accessing HCBS in some states. More broadly, Medicare, Medicaid, and private insurers increased access to telehealth services during the pandemic, which may have enabled people with disabilities to access medical care more easily than in-person visits. Broad Medicare coverage of telehealth is set to expire at the end of 2024 and other payers may also limit their coverage, which could reduce the increased access to care.

Long COVID may have disproportionately affected people with disabilities, but it may also cause higher rates of disability moving forward. Long COVID can create or exacerbate challenges in meeting basic needs and a December 2022 survey found that substantial numbers of people with long COVID—many of whom also had other disabilities—were having difficulty paying their bills are accessing sufficient food.

How are people with disabilities accessing the supports and services they need when average wait times for disability claims are at an all-time high and clerical errors result in missing benefits or notices that people must repay prior years’ benefits? Long wait times make it difficult for people to access benefits when they need them creating unique challenges for the 21.8 million working-age adults living with disabilities in the United States. For those that receive disability benefits through the social security programs, many are finding their benefits reduced on account of overpayments they owe because of past errors on the part of the Social Security Administration. The Administration has been sending overpayment notices to more than 2 million people each year, which ask recipients to repay the government within 30 days. In many cases, those payments had been made years earlier without the recipients’ knowledge. By the time they had been identified, the overpayment amounts may be far larger than people can repay, measured in tens or even hundreds of thousands of dollars. When beneficiaries are unable to repay the money, the government may reduce their monthly benefits. The Senate Finance Committee is expanding oversight of the Social Security Administration to address such issues, but it’s unclear how long it will take to sort through the prior clerical errors and to address the wait times.

How will Medicaid redeterminations affect coverage for people with disabilities? Medicaid plays an important role in helping working-age adults to access the health and long-term services and supports they need and the next year or so may present difficulties as states redetermine Medicaid eligibility for the first time in over three years. At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act, which required states to keep people continuously enrolled as a condition of receiving additional federal funding, but that requirement ended March 31, 2023, and states have begun disenrolling people who are no longer eligible or who do not submit complete and timely paperwork, resulting in many millions of people losing Medicaid coverage. Although Medicaid renewals are challenging for all types of enrollees, redeterminations may require more paperwork for people who are eligible on the basis of disability; and the loss of health coverage is especially likely to disrupt access to ongoing health care.

How might a new proposed rule regarding nondiscrimination based on disability be finalized and when finalized, affect people with disabilities? On September 7, 2023, the Office of Civil Rights within the Department of Health and Human Services published a proposed update to the regulations that prohibit discrimination based on disability by recipients of federal funding. The proposed rule is the first comprehensive update of the regulations since they were established more than 40 years ago and the new requirements would strengthen protections for people with disabilities. The proposed rule would address discrimination in medical treatment and child welfare programs, establish accessibility standards for web and mobile delivery of health and human services benefits, and establish enforceable standards for accessible medical equipment. It would also codify the Olmstead court decision that requires services to be provided in the most integrated setting appropriate. Often, the most appropriate settings are financed through Medicaid home- and community-based services, but many of those programs have waiting lists for people to access care. It is unknown how the final requirements will compare to the proposed rule, but the new regulation is intended to help people with disabilities better access health care and social services.

How might a proposed change to the definition of disability in the American Community Survey affect people with disabilities and funding for programs that provide housing, transportation, health care, and education? Currently, the survey asks people whether they have difficulty with hearing, vision, cognition, ambulation, self-care, or independent living using a yes/no answer option. The proposed change would tweak the wording of the questions, but the biggest change is that respondents would be given four answer options instead of two: no difficulty, some difficulty, a lot of difficulty, and cannot do at all. The new questions and answers were developed in recognition that disability is a complex topic that may be difficult to define with a yes or no framework, to better identify people who may be at risk of restricted social participation, and to enable international comparisons. Under the proposal, people would be counted as having a disability if they reported they cannot do something at all or have a lot of difficulty, which could reduce the percentage of people with disabilities by 40%, raising concerns among people with disabilities, advocates for programs serving people with disabilities, and researchers using the data. Advocates and researchers note that the American Community Survey data are used for enforcing civil rights and allocating federal funding, which means changing the questionnaire could have significant policy implications.

As the 25th anniversary of Olmstead nears, more than one-in-10 working age adults have a disability and most do not receive public disability income. 

Over one-in-10 working-age adults reported having a disability in 2022. A disability is defined as having difficulty with hearing, vision, cognition, ambulation, self-care, or independent living, according to KFF’s examination of data on people with disabilities from the American Community Survey.

Fewer than a third of working-age adults with disabilities receive any income from social security programs, including Social Security Disability Insurance and Supplemental Security Income. Meanwhile, they are almost twice as likely to have income below 200% Federal Poverty Level compared with adults without disabilities. They are also more likely to have Medicaid and could face greater paperwork challenges during Medicaid redeterminations.

In many states, COVID-era policies that increased access to home and community-based services are ending, which may create additional barriers to care for some people with disabilities. 

As people with disabilities struggle to access and maintain the supports and services they need, average wait times for disability claims are at an all-time high and current recipients may be missing benefit payments on account of past clerical errors. 

A new proposed rule could address discrimination against people with disabilities in medical treatment and child welfare programs, establish accessibility standards for web and mobile delivery of health and human services benefits, and establish enforceable standards for accessible medical equipment. It would also codify the Olmstead court decision that requires services to be provided in the most integrated setting appropriate.

This fact sheet does not reflect recent changes that have been implemented by the Trump administration, including a foreign aid review and restructuring. For more information, see KFF’s Overview of President Trump’s Executive Actions on Global Health.

Key Facts

• Improving access to family planning and reproductive health (FP/RH) services globally can help prevent maternal deaths and reduce unintended pregnancies. Each year, an estimated 287,000 women die from complications during pregnancy and childbirth, almost all in low- and middle-income countries. Approximately one-third of maternal deaths could be prevented annually if women who did not wish to become pregnant had access to and used effective contraception. Worldwide, 218 million women have an unmet need for modern contraception.
• The U.S. government (U.S.) has supported global FP/RH efforts for nearly 60 years and is the largest donor to FP/RH in the world. It is also one of the largest purchasers and distributors of contraceptives internationally.
• Over time, the U.S. role in global FP/RH has changed, sometimes influenced by differing views and political debates related to FP/RH that have arisen both domestically and internationally. Historically, these debates have concerned both the amount of U.S. funding provided as well as its use, particularly related to abortion.
• U.S. funding for FP/RH rose steadily in its first three decades but has remained relatively flat in recent years at approximately $600 million. In FY 2023, U.S. funding totaled $608 million, including funding for the United Nations Population Fund (UNFPA). After the Trump administration withheld funding from UNFPA from FY 2017 – FY 2020, under the Kemp-Kasten Amendment, it was restored by the Biden administration in FY 2021.
• U.S. funding for FP/RH is governed by several other legislative and policy requirements, including a legal ban on the direct use of U.S. funding overseas for abortion as a method of family planning (the Helms Amendment, which has been in place since 1973) and, when in effect, the Mexico City Policy (reinstated and expanded by President Trump as the “Protecting Life in Global Health Assistance” policy but rescinded by President Biden upon taking office).

Global Situation

Access to family planning and reproductive health (FP/RH) services is critical to the health of women and children worldwide. Improving access to FP/RH services globally can help prevent maternal deaths and reduce unintended pregnancies. Each year, approximately 287,000 women die from complications during pregnancy and childbirth, almost all in developing countries and most in sub-Saharan Africa and South and Central Asia.¹  It is also estimated that approximately one-third of maternal deaths could be prevented annually if women who did not wish to become pregnant had access to and used effective contraception.² 

Key Factors

Key factors contributing to maternal deaths and unintended pregnancy include:⁵ 

• unmet need for FP services;
• high adolescent birth rates, since adolescents (ages 15-19) are more likely to die or face complications during pregnancy and childbirth;
• lack of access to antenatal care, which increases the risk of complications during pregnancy and childbirth; and
• unsafe abortions, which are those performed by individuals without the necessary skills or in an unsanitary environment and often lead to complications and death.

Worldwide, 218 million women have an unmet need for modern contraception (i.e., they do not wish to get pregnant and are using no contraceptive method or a traditional method).⁶  Access to modern FP methods varies significantly by region. Unmet need for modern FP is highest in regions like sub-Saharan Africa, Oceania, and Western Asia where modern contraceptive prevalence is low.⁷  Adolescent fertility rates have declined slowly and remain particularly high in sub-Saharan Africa, where child marriage remains common, and in Latin America and the Caribbean as well as Oceania.⁸  While the percentage of pregnant women receiving the recommended minimum number of four antenatal care visits has been on the rise, it is 49% in the least developed countries and has reached only 54% in sub-Saharan Africa and 55% in South Asia.⁹  Each year, approximately 47,000 women die from complications associated with unsafe abortion.¹⁰  Access to and use of effective contraception reduces unintended pregnancies and the incidence of abortion.¹¹ 

Reasons for the lack of access to and, in some cases, utilization of FP/RH services include low awareness of the risks of sexual activity, such as pregnancy and HIV; cost; gender inequality; and laws in some countries that require women and girls to be of a certain age or have third party authorization, typically from their husband, to utilize services.¹² 

Interventions

FP/RH encompasses a wide range of services that have been shown to be effective in decreasing the risk of unintended pregnancies, maternal and child mortality, and other complications. These include:

• birth spacing;
• contraception;
• sexuality education, information and counseling;
• post-abortion care;
• screening/testing for HIV and other sexually transmitted diseases (STDs);
• repair of obstetric fistula;
• antenatal and postnatal care;
• genital human papillomavirus (HPV) vaccine to prevent cervical cancer and genital warts; and
• research into new methods such as microbicides.¹³ 

SDG 3: Achieving Universal Access to Reproductive Health

This goal, adopted in 2015 as part of Sustainable Development Goal (SDG) 3 – “ensure healthy lives and promote well-being for all at all ages,” is to “ensure universal access to sexual and reproductive health care services, including for family planning, information, and education, and the integration of reproductive health into national strategies and programmes”¹⁴  by 2030.

U.S. Government Efforts

The U.S. has a long history of engagement in international family planning and population issues, and today, the U.S. government is the largest donor to global FP/RH efforts and is one of the largest purchasers and distributors of contraceptives internationally.¹⁵  Congress first authorized research in this area in the Foreign Assistance Act of 1961.¹⁶  In 1965, the U.S. Agency for International Development (USAID) launched its first FP program and, in 1968, began purchasing contraceptives to distribute in developing countries. In the 1980s, USAID programs expanded to address maternal, newborn, and child health as well as the relationship between population, health, and the environment; and in the 1990s, USAID FP/RH programs began to recognize the need for male involvement in FP/RH and focus on the needs of young people.¹⁷  More recently, the U.S. adopted a longer term global health goal of ending preventable child and maternal deaths by 2035 and highlighted the important role of FP/RH efforts in achieving this goal.¹⁸  U.S. funding for FP/RH is governed by several legislative and policy requirements, including a legal ban on the direct use of U.S. funding overseas for abortion as a method of family planning (which has been in place since 1973) as well as more stringent restrictions in some years, such as the Mexico City Policy (see below).

Organization

USAID has long served as the lead U.S. agency for FP/RH activities, with other agencies also carrying out FP/RH activities.

USAID

USAID operates FP/RH programs in more than 30 countries, with a focused effort in 24 priority countries that are mostly in Africa and Southern Asia.¹⁹  The agency’s stated FP/RH objective is to help countries meet the FP/RH needs of their people.²⁰  It does this by expanding sustainable access to quality voluntary FP/RH services, commodities, and information (see Table 1²¹ ) that enhance efforts to reduce high-risk pregnancies; allow sufficient time between pregnancies; provide information, counseling, and access to condoms to prevent HIV transmission; reduce the number of abortions; support women’s rights by improving “women’s opportunities for education, employment, and full participation in society;” and stabilize population growth by advancing “individuals’ rights to decide their own family size.”²² 

Other U.S. FP/RH Efforts

Also carrying out FP/RH efforts are the Centers for Disease Control and Prevention (CDC) (research, surveillance, technical assistance, and a designated World Health Organization Collaborating Center for Reproductive Health);²³  the Department of State (diplomatic and humanitarian efforts); the National Institutes of Health (NIH) (research); and the Peace Corps (volunteer activities).

Additionally, USAID’s FP/RH and maternal and child health (MCH) efforts are closely linked, although Congress directs funding to and USAID operates these programs separately. Recent years have also seen greater emphasis on coordinating FP/RH investments with global HIV efforts through the President’s Emergency Plan for AIDS Relief (PEPFAR).²⁴  See the KFF fact sheet on U.S. MCH efforts and the KFF fact sheet on U.S. PEPFAR efforts.

Multilateral Efforts

The U.S. works with several international institutions, partnerships, and other donors to carry out FP/RH efforts. Among them are the U.N. Population Fund (UNFPA, the largest purchaser and distributor of contraceptives worldwide); Family Planning 2030 (FP2030, an international partnership to expand access to rights-based family planning services in which the U.S. is a core partner²⁵ ); and the Global Financing Facility (GFF, a partnership to advance the health and rights of women, children, and adolescents through innovative financing, in which the U.S. is an investor and has recently enhanced its cooperation with a focus on how their combined efforts may further strengthen primary health care).²⁶ 

Funding²⁷ 

U.S. funding for FP/RH rose steadily in its first three decades²⁸  but then declined for several years before peaking at $715 million in FY 2010. More recently, funding has been relatively flat at approximately $600 million. Total U.S. funding for FP/RH, which includes the U.S. contribution to UNFPA, was $608 million in FY 2023 (see figure for the latest information). In several years during this period, the Trump administration withheld the U.S. contribution to UNFPA (FY 2017 – FY 2020) due to the Kemp-Kasten Amendment.²⁹  (See the KFF fact sheet on the U.S. Global Health Budget: Family Planning & Reproductive Health (FP/RH) and the KFF budget tracker for more details on historical appropriations for U.S. global FP/RH efforts.)

Most U.S. funding for FP/RH is part of the Global Health Programs account at USAID, with additional funding provided through the Economic Support Fund account. FP/RH funding is also provided through the International Organizations & Programs account at the Department of State for the U.S. contribution to UNFPA. Under current U.S. law, any U.S. funding withheld from UNFPA is to be made available to other family planning, maternal health, and reproductive health activities.³⁰ 

Requirements in Law and Policy³¹ 

Legal, policy, and programmatic requirements for U.S. funding for international FP include (also see the KFF fact sheet on these and other requirements):

Helms Amendment

Since 1973, through the Helms Amendment, U.S. law has prohibited the use of foreign assistance to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion.

Mexico City Policy

First instituted by President Reagan in 1984 through executive order, the Mexico City Policy (the “Global Gag Rule”) required foreign non-governmental organizations (NGOs) to certify that they would not perform or promote abortion as a method of family planning using funds from any source as a condition for receiving U.S. funding. A highly debated issue, this policy was rescinded by President Clinton, reinstated by President Bush, rescinded by President Obama, and reinstated – in an expanded form – by President Trump in January 2017. The Trump administration’s application of the policy extended to the vast majority of U.S. bilateral global health assistance, including funding for FP/RH, HIV under PEPFAR, maternal and child health, malaria, nutrition, and other programs; in past iterations, it applied to family planning assistance only, and under that administration, the policy was renamed “Protecting Life in Global Health Assistance.” The Biden administration rescinded the policy in January 2021. See the KFF explainer on the Mexico City Policy.

UNFPA & the Kemp-Kasten Amendment

Although the U.S. government helped create the U.N. Population Fund (UNFPA) in 1969 and was a leading contributor for many years, there have been several years in which funding has been withheld due to executive branch determinations that UNFPA’s activities in China violated the Kemp-Kasten Amendment, which prohibits funding any organization or program, as determined by the President, that supports or participates in the management of a program of coercive abortion or involuntary sterilization.³²  The Kemp-Kasten Amendment was most recently invoked to withhold funding for UNFPA for four years (FY 2017 – FY 2020) during the Trump administration; see the KFF explainer on UNFPA funding and the Kemp-Kasten Amendment.

Voluntarism and Informed Choice

The principles of ensuring voluntary use of FP/RH services as well as informed choice of FP/RH options are specified in legislative language and program guidance.

1. World Health Organization (WHO), et al., Trends in maternal mortality: 2000 to 2020, 2023; WHO, “Maternal mortality,” fact sheet, Feb. 22, 2023. ↩︎
2. S. Ahmed, et al., “Maternal deaths averted by contraceptive use: an analysis of 172 countries,” The Lancet, July 14, 2012 (Vol. 30, no. 9837: 111-125). ↩︎
3. WHO, Family Planning website, https://www.who.int/health-topics/contraception#tab=tab_1. ↩︎
4. WHO, Reproductive Health website, https://www.who.int/teams/sexual-and-reproductive-health-and-research-(srh)/overview; International Conference on Population and Development (ICPD), Programme of Action, Cairo, 1994. ↩︎
5. WHO, “Maternal mortality,” fact sheet, Sept. 2019; United Nations (UN), The Millennium Development Goals Report 2009, 2009; WHO, World Health Report 2005 – Making Every Mother and Child Count, 2005; Guttmacher Institute, “Unintended Pregnancy and Abortion Worldwide,” fact sheet, July 2020; WHO, “Preventing unsafe abortion,” fact sheet, Sept. 2020. ↩︎
6. Guttmacher Institute, Adding It Up: Investing in Sexual and Reproductive Health 2019, 2020. ↩︎
7. Oceania excludes Australia and New Zealand. U.N. Department of Economic and Social Affairs, Population Division, Estimates and Projections of Family Planning Indicators 2022: Regions, 2022. ↩︎
8. Oceania excludes Australia and New Zealand. U.N., Progress towards the Sustainable Development Goals, Report of the Secretary-General 2023, Supplementary Information, statistical annex, undated, https://unstats.un.org/sdgs/files/report/2023/E_2023_64_Statistical_Annex_I_and_II.pdf. ↩︎
9. UNICEF, “Table 3: Maternal and Newborn Health,” in State of the World’s Children 2023, 2023. ↩︎
10. WHO, Unsafe abortion: global & regional estimates of the incidence of unsafe abortion and associated mortality in 2008, 2011. See also WHO, “Abortion,” fact sheet, Nov. 2021. ↩︎
11. Eric Zuehlke, “Reducing Unintended Pregnancy and Unsafely Performed Abortion Through Contraceptive Use,” PRB, 2009. See also WHO, “Abortion,” fact sheet, Nov. 2021. ↩︎
12. WHO, World Health Report 2005 – Making Every Mother and Child Count, 2005. See also Guttmacher Institute, Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method, June 2016, and Guttmacher Institute, “Reasons for Unmet Need For Contraception in Developing Countries,” fact sheet, June 2016. ↩︎
13. USAID, “Family Planning & Reproductive Health Programs – Saving Lives, Protecting the Environment, Advancing U.S. Interests,” fact sheet, undated; USAID, “Fast Facts: Family Planning,” fact sheet, Dec. 2009; WHO, Johns Hopkins, and USAID, Family Planning: A Global Handbook for Providers, 2007; USAID, Report to Congress: Global Health and Child Survival Progress Report – FY 2008, 2009; UNESCO, International Technical Guidance on Sexuality Education, Dec. 2009. ↩︎
14. UN, Transforming our world: the 2030 Agenda for Sustainable Development, 2015. This goal was originally specified in the 1994 Cairo International Conference on Population and Development’s (ICPD) Programme of Action and was added in 2007 as a specific target of Millennium Development Goal 5 (MDG 5), which aims to improve maternal health. This addition to MDG 5 was a recognition by governments and world leaders of the need to address challenges related to access and utilization of RH services. The world did not reach this target, but some progress was made, with more women attending a health provider four times or more during pregnancy and using contraceptives, though these indicators still vary widely across regions. ICPD, Programme of Action, Cairo, 1994; UN, The Millennium Development Goals Report 2009, 2009; UN, The Millennium Development Goals Report 2015, 2015. ↩︎
15. KFF, Mapping the Donor Landscape in Global Health: Family Planning and Reproductive Health, 2014; KFF, Donor Government Assistance for Family Planning, report series; UNFPA, Contraceptives and Condoms for Family Planning and STI & HIV Prevention (2014), 2015. ↩︎
16. Congressional Research Service (CRS), U.S. International Family Planning Programs: Issues for Congress, Jan. 2016. ↩︎
17. USAID, USAID Family Planning Program Timeline, undated. ↩︎
18. USAID, “What We Do – Global Health,” webpage, https://www.usaid.gov/global-health; USAID: Acting on the Call: Ending Preventable Child and Maternal Deaths, June 2014; USAID: Acting on the Call: Ending Preventable Child and Maternal Deaths, June 2014. See also USAID, Acting on the Call 2018: A Focus on the Journey to Self-Reliance for Preventing Child and Maternal Deaths, 2018. ↩︎
19. KFF analysis of data from the U.S. Foreign Assistance Dashboard website, ForeignAssistance.gov. See also USAID, “Family Planning Countries,” webpage, https://www.usaid.gov/global-health/health-areas/family-planning/countries. Countries are selected based on high rates of unmet need for FP, prevalence of high-risk births, low contraceptive use, and significant population pressures on land and water resources (per KFF personal communication with USAID, April 2, 2010). ↩︎
20. USAID, “Family Planning and Reproductive Health Program Overview,” fact sheet, Oct. 2023. ↩︎
21. USAID, “Family Planning and Reproductive Health Program Overview,” fact sheet, Oct. 2023; U.S. Government, FY 2019 Congressional Budget Justification – Department of State, Foreign Operations, and Related Programs, 2018; USAID, “Family Planning and Reproductive Health Program Overview,” fact sheet, Nov. 2017; USAID: “Family Planning and Reproductive Health,” webpage, https://www.usaid.gov/global-health/health-areas/family-planning; USAID, “Family Planning Resources,” webpage, https://www.usaid.gov/global-health/health-areas/family-planning/resources; USAID, “Reproductive Health,” webpage, https://www.usaid.gov/global-health/health-areas/reproductive-health; USAID, “Family Planning & Reproductive Health Programs – Saving Lives, Protecting the Environment, Advancing U.S. Interests,” fact sheet, undated; USAID, “Fast Facts: Family Planning,” fact sheet, Dec. 2009. ↩︎
22. USAID, “Family Planning and Reproductive Health Program Overview,” fact sheet, Oct. 2023; USAID, “Family Planning and Reproductive Health Program Overview,” fact sheet, Nov. 2017; USAID: “Family Planning and Reproductive Health,” webpage, https://www.usaid.gov/global-health/health-areas/family-planning; USAID, Report to Congress: Global Health and Child Survival Progress Report – FY 2008, 2009. ↩︎
23. CDC, Global Reproductive Health website, http://www.cdc.gov/reproductivehealth/Global/index.htm. ↩︎
24. For example: OGAC, PEPFAR 2018 Country Operational Plan Guidance for Standard Process Countries, Jan. 28, 2018; OGAC, PEPFAR Fiscal Year 2014 Country Operational Plan (COP) Guidance, Version 2, Nov. 8, 2013; OGAC, PEPFAR Blueprint: Creating An AIDS-free Generation, Nov. 2012; OGAC, U.S. PEPFAR: Five-Year Strategy, Dec. 2009. ↩︎
25. FP2030, “About FP2030,” webpage, https://fp2030.org/about. ↩︎
26. The GFF was launched in 2015 as a multi-stakeholder partnership that supports country-led efforts to advance the health and rights of women, children, and adolescents, and the U.S. is as a member of the Investors Group that oversees the partnership’s overall activities. GFF, “About,” webpage, https://www.globalfinancingfacility.org/about; GFF, “Governance,” webpage, https://www.globalfinancingfacility.org/governance; GFF, “Investors Group,” webpage, https://www.globalfinancingfacility.org/governance/investors-group. ↩︎
27. KFF analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, Congressional Appropriations Bills, and U.S. Foreign Assistance Dashboard website, ForeignAssistance.gov. ↩︎
28. PAI, Cents and Sensibility: U.S. International Family Planning Assistance from 1965 to the Present, webpage, https://pai.org/cents-and-sensibility/. ↩︎
29. Congress has usually required that funding withheld from UNFPA be reallocated to USAID’s family planning, maternal, and reproductive health activities. See KFF, UNFPA Funding & Kemp-Kasten: An Explainer. ↩︎
30. KFF, UNFPA Funding & Kemp-Kasten: An Explainer. ↩︎
31. KFF, The U.S. Government and International Family Planning & Reproductive Health: Statutory Requirements and Policies, fact sheet; KFF, Statutory Requirements & Policies Governing U.S. Global Family Planning and Reproductive Health Efforts, brief, 2012; USAID, USAID’s Family Planning Guiding Principles and U.S. Legislative and Policy Requirements webpage, https://www.usaid.gov/global-health/about-us/policy-requirements. ↩︎
32. CRS, The United Nations Population Fund (UNFPA): Background and U.S. Funding, May 2022; CRS, The U.N. Population Fund: Background and the U.S. Funding Debate, Feb. 2010. ↩︎

In September 2023, the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to leverage federal funding on health care: the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. With this model, CMS–under the auspices of the CMS Innovation Center, also known as CMMI–aims to reduce the rate of growth in health care spending, improve people’s health, and reduce disparities in health outcomes. To achieve those broad aims, state demonstration programs will involve multiple programs and strategies, but the key feature of the model is prospective lump sum payments to participating hospitals that cover the costs of providing all inpatient and outpatient care to a pre-defined patient population. The lump sum payments would cover Medicaid enrollees, certain Medicare beneficiaries, and people who are covered by one or more private payers. Up to eight participating states would also be eligible for a planning grant of up to $12 million each to design and implement the model. This issue brief answers some key questions about the new model and explores considerations for potential state and private participants.

What is the AHEAD model?

The AHEAD model is an 11-year program (2024 – 2034) offering states the opportunity to leverage federal funding to make broad changes in the way health care is provided and paid for. The optional program would involve multiple payers of health care, including Medicaid, fee-for-service (FFS) Medicare, and at least one private payer. Applicants must be state agencies and include the state’s Medicaid agency, and the demonstration may be either statewide or limited to a particular region within the state. CMS developed the model to encourage and build on the successes of existing programs in Maryland, Pennsylvania, and Vermont (Box 1). AHEAD aims to limit total health spending, increase investments in primary care, change the way hospitals are paid, and connect people with increased social services that are important in supporting health. Specific components of the model include the following.

• The AHEAD model aims to increase the percentage of health care spending that goes to primary care, and participating primary care practices will receive new care management fees to promote person-centered care. The specific mechanisms for supporting primary care will vary by state, leveraging existing Medicaid and Medicare models, but in general, participating practices will receive new funding to improve health care coordination, integrate behavioral health care, and identify and facilitate interventions to address social needs such as housing, food, and energy insecurity. Participants will be held accountable for meeting pre-specified performance targets related to quality and equity.
• Participating states are required to recruit hospitals, but participation for hospitals within the state is voluntary. Participating hospitals would switch from being paid primarily based on the number of people served or number of services provided to a “global budget,” under which the hospitals receive a prospective, predetermined amount to provide all inpatient and outpatient care to specified patient populations. The global budgets are established using payer-specific historic spending and updated annually to account for population changes and inflation, providing hospitals with a predictable funding stream. Hospital-specific performance and equity targets will be established to deter hospitals from stinting on high-cost procedures, avoiding high-risk patients, and reducing quality.
• To promote the model’s equity goals, participating states and hospitals must develop their own health equity plans. Health equity tools will include—at a minimum—adjusting payment rates for people’s health and social risk factors and providing hospitals with bonus payments if they meet performance targets on equity.
• States will be accountable for limiting the growth of total health care spending within the state and are expected to leverage their legislative or regulatory authority to hold private payers accountable too. By the end of the second year, participating states must have at least one private payer participating in hospital global budgets. States may meet that requirement with participation from one or more of the following: private insurance plans, state employee health plans, Medicare Advantage (MA) plans, and others.

What are the opportunities and requirements for states that participate?

The AHEAD model offers states many opportunities, but also includes many requirements, and may not be a viable option for all states. CMS describes the requirements for state, hospital, and primary care provider participants in its overview of the AHEAD model, in the frequently-asked-questions page, and in the description of the grant opportunity. Those resources summarize program goals and benefits for certain participants, but success will depend on a state’s ability to engage private parties, which in turn, face their own opportunities and requirements for participation (Table 1). AHEAD offers states the opportunity to leverage federal funding to achieve statewide improvements in health and equity while restraining total health spending, including state spending for Medicaid. But the model makes major changes to how providers are paid and requires buy-in from private entities. After the model begins, participating states, hospitals, and primary care practices will be required to meet a wide range of participant-specific performance targets with corrective action plans required for states that do not meet the specified targets.

Of the model’s requirements, hospital global budgets may be the most potentially controversial because of the significant regulatory framework they require. States must develop and implement Medicaid global budgets and may need to support global budget methodologies for other payers, including private insurers. CMS will develop and maintain a standardized methodology for Medicare FFS global budgets, but states may develop and implement state-specific systems with CMS’ approval.

What to watch as the model unfolds?

Will states be interested in applying when the application period opens in the spring of 2024? It is not clear whether states are interested in applying yet. The model will require significant state efforts and it is unknown whether participation will yield reduced spending or improved outcomes. Existing multi-payer models in Maryland, Pennsylvania, and Vermont have shown promising—but limited (Box 1)—results and are one of the motivations for CMS’ broader AHEAD model. (CMS has encouraged those three states to apply as a strategy to sustain their initiatives currently underway.) When states submit their applications, they select one of three cohorts to participate in, with cohorts having rolling start dates to being their planning, and eventually, implementation activities. Timing will depend on the cohort, but in general, planning activities will occur between July 2024 and December 2026 and implementation will occur between January 2026 and January 2027. The models will run through the end of 2034.

Will states be able to engage employers and private insurers to meet the goal of restraining the growth in spending on health care? The AHEAD model only requires one private payer to participate in hospital global budgets, and that requirement may be met by participation from a MA or state employee plan, among others. However, states may have difficulty meeting spending targets in the absence of meaningful participation from private payers. To measure performance in curbing spending growth, CMS will develop projected growth rates for Medicare and all-payer health care spending using state-specific historical spending data. States will be held responsible for keeping actual spending by Medicare FFS and all payers below those projected growth rates. States may use their legal authority to compel participation or other changes among private insurers, but that approach could create political resistance. Further, states do not have legal authority over employer plans in which the employer pays some or all costs directly from their own funds (e.g., self-funded plans). Therefore, achieving buy-in from all payers will require models that private payers and employers see as advantageous and opt to join.

Will states with significant enrollment in Medicaid managed care or MA elect to participate? States with significant enrollment in Medicaid managed care organizations (MCOs) or MA will need to engage those plans to meet spending targets. Significant use of Medicaid MCOs or enrollment in MA does not preclude participation in the model but will require states to partner with the private plans delivering services if the state is to meet overall spending targets. (Applicants will also need to make sure they have at least 10,000 Medicare beneficiaries enrolled in Medicare’s FFS program.) Maryland and Pennsylvania are useful examples for states to consider if they are interested in AHEAD and have significant MCO or MA enrollment because CMS has modeled the program after their demonstrations and encouraged both states to apply. The two states rely heavily on MCOs to provide Medicaid services: 85% of enrollees in Maryland and 92% in Pennsylvania are enrolled in Medicaid managed care. Both states also have measurable enrollment in MA, although, Maryland’s rate is lower than that of most states: 52% in Pennsylvania and 24% of Medicare beneficiaries in Maryland are enrolled in MA.

What types of hospitals will be able to participate most easily? For hospitals, the shift from emergent and inpatient hospital care to primary and outpatient care could mean forgone revenues from high-cost services. Hospitals that have already acquired primary care practices may be keener to participate as forgone revenues would be replaced with increased payments for primary care. In states where participating hospitals have already acquired a greater share of the region’s outpatient practices, the global budgets will capture a larger percentage of overall health care spending.

Could AHEAD encourage hospitals to acquire additional physician practices (vertical consolidation)? The AHEAD model only applies to services that are provided by participating hospitals and primary care providers. If the model spurs additional vertical consolidation (such as hospitals buying new specialty groups), a bigger share of health care spending would fall under the model’s global budgets. Previous research shows that vertical consolidation often results in higher prices without any corresponding gains in quality. However, the AHEAD model’s global hospital budgets will be set to limit the growth of health care spending. To the extent that vertical consolidation increases in AHEAD states and regions, private payers may be encouraged to participate in hopes of limiting their cost increases stemming from higher prices for vertically integrated systems.

How will CMS evaluate improvements in population health, equity, and the quality of care? The AHEAD model’s goals—lower health care spending, improved population health and health equity, and higher-quality care—may in some cases be in conflict; and CMS has included a multi-faced quality and population health strategy to ensure that reduced spending does not result in inferior health-related outcomes. Key to measuring outcomes will be enhanced demographic data collection, which requires participating hospitals and primary care practices to collect and report self-reported patient demographic data. Under the quality and population health strategy (Appendix X in the grant application materials), participating states, hospitals, and primary care providers will be evaluated on outcomes related to population health and the quality of care. Measures will be evaluated for subpopulations using demographic data to address health disparities within the state. Participating states and providers will be required to meet overall targets and targets for sub-populations. Specific sub-populations are not enumerated in the grant materials, but they will be defined based on currently observed health disparities.

Given the broad range of quality measures participants must meet, will there be sufficient providers and social resources for participants to meet those goals? States will be required to select at least one quality measure from the following categories: population health (measures will be drawn from the Behavioral Risk Factor Surveillance System), prevention and wellness (e.g., cancer screening), chronic conditions (e.g., management of high blood pressure or diabetes), behavioral health (e.g., treatment of opioid use disorder or depression), quality of care (e.g., hospital readmissions), and other measures (maternal health, preventive care, or social drivers of health). The quality and population health strategy will include people’s experiences with care, including outcomes from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. For states to improve population health across all dimensions, people will need access to health care and in some cases, assistance with social needs such as housing, food, and energy insecurity. While it is accepted that access to housing, food, and energy has a direct impact on health, health programs have traditionally had a limited role in addressing those issues. For example, Medicaid managed care plans may screen for unmet needs, refer people to services, and work with community-based organizations to provide access to assistance, but few plans directly deliver the services or track outcomes. Recent guidance has expanded opportunities for states to use Medicaid to address social needs. Recognizing that many people have insufficient access to housing, food, and energy assistance, states may find that increasing Medicaid’s role in providing such assistance supports meeting the broad goals enumerated under the AHEAD model.

KFF has conducted this annual survey since 1999. The archives include surveys conducted in partnership with the Health Research and Education Trust through 2017 and a small business supplement of the 1998 survey conducted by KFF. The survey was previously conducted by KPMG from 1991–1998 and the Health Insurance Association from 1987–1991. The survey, which is traditionally released each Fall, tracks trends in employer health insurance coverage, the cost of that coverage, and other topical health insurance issues. Findings are based on a nationally representative survey of public and private employers with three or more employees, including those who respond to the full survey and those who indicate only whether or not they provide health coverage.

2023 | 2022 | 2021 | 2020 | 2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | 1999 | 1998 |

2023Full Report (.pdf)

2022Full Report (.pdf)

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2015Full Report (.pdf)

2014Full Report (.pdf)2013Full Report (.pdf)2012Full Report (.pdf)

NOTE: In 2011, our methodology for calculating employer weights was updated.  Statistics such as the percentage of firms offering health benefits or the percentage of firms offering retiree coverage are updated in the preceding reports.  Statistics based on the percentage of covered workers were not affected by this change.  Most changes were not statistically different.  For more information, see the Survey Design and Methods Section in the 2011 Report.

2011

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NOTE: In 2003, our methodology for calculating weights was updated. New estimates for many statistics published in 1999-2002 are available in the preceding reports.  Most changes were not statistically different.  For more information, see the Survey Design and Methods Section in the 2003 Report.

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Here’s a look back at 10 issues KFF tracked closely this year with some of our top findings summarized:

Health care costs continue to be a burden for many Americans: From our data showing that family health insurance premiums for employer coverage rose 7% to nearly $24,000 this year—and became unaffordable for many workers at small employers — to our series on “Dying Broke” focused on how older Americans struggle to pay for long-term care—the health care affordability crisis continues to plague Americans and remain a top issue going into the 2024 election. And, while anti-obesity drugs captured a lot of attention, coverage, cost, and access is unclear. More than 100 million people in America—41% of adults—have medical bills they can’t pay.

Access to Abortion and contraception remained top issues for voters following the Supreme Court’s decision to overturn Roe v. Wade last year. We tracked state abortion policies and litigation throughout the year, and also explored the right to contraception across the U.S. Our newsroom dove into how the issue is playing out nationally and in the states. Abortion also played a role in Congressional discussions about reauthorizing PEPFAR, the U.S.’ signature program to provide HIV prevention and treatment services to millions, saving more than 25 million lives over 20 years.

Medicaid enrollment began to dip, with further drops expected. Our annual survey of state Medicaid directors found that states expect national Medicaid enrollment will decline by 8.6% in state fiscal year 2024 as state Medicaid agencies continue to unwind pandemic-related continuous enrollment protections. As of Dec. 13, more than 12 million people have been disenrolled from Medicaid due to unwinding. Some subsequently regained coverage, so the net enrollment decline will be lower. At the same time, North Carolina just this month expanded their Medicaid programs to cover low-income adults, joining 39 other states and the District of Columbia.

Medicare drug price negotiations began, which were authorized as part of last year’s Inflation Reduction Act, but with significant debate by the drug industry. Medicare open enrollment concluded on Dec. 7, and we heard from Medicare beneficiaries about their views on marketing practices, looking for options, and their coverage. Many seniors let their plans renew automatically.

Covid was still a thing but Americans began to worry less about the pandemic, and their chances of getting sick, as our COVID-19 Vaccine Monitor showed. Interest in getting the latest booster waned even though most Black and Hispanic adults expected to get it while most White adults did not. Plus, following the end of the public health emergency declaration in May, finding a booster and paying for it was confusing for many, prompting a “cheat sheet” to help figure it out.

Misinformation continued to be prevalent across health issues, and KFF found that at least four-in-10 people say they’ve heard each of 10 specific false claims but relatively few believe those claims are definitely true. Most are simply uncertainty, which creates a “muddled middle,” that can be reached with reliable information from trusted sources, such as doctors and local television news.

Advancing health equity remains a top issue for health policy experts and researchers. New survey research from KFF showed that six-in-10 Black adults, about half of American Indian and Alaska Native and Hispanic adults, and four-in-10 Asian adults say they prepare for possible insults from providers or staff and/or feel they must be very careful about their appearance to be treated fairly during health care visits at least some of the time. KFF Health News also continued its coverage of how health outcomes differ based on race and ethnicity.

Everything old is new again? And, to close out the year, we heard from former President Trump and Gov. Ron DeSantis (R-FL), that they want to replace or alter the Affordable Care Act (ACA). KFF’s polling shows that Americans broadly support the ACA, with more than twice the share of Democratic voters (70%) than Republican voters (32%) saying it’s a very important issue for the candidates to discuss. Plus, there’s been record enrollment in the ACA marketplace this year. KFF Health News explored the issues in its “What the Health” podcast episode and in its summary of related media coverage.  

Employer-sponsored health insurance (ESI) is the largest source of health coverage for non-elderly people, covering 60.4% of this population in March 2023. Not all workers have access to ESI, however; some workers are in jobs where the employer does not offer coverage (usually smaller employers) and some workers are not eligible for the coverage offered at their job. Additionally, some workers do not enroll in the ESI they are offered.

This chart collection presents analysis of data from recent Annual Economic and Social (March) Supplements (ASEC) of the Current Population Survey (CPS) to examine who among non-elderly people has ESI and which workers are offered and eligible for coverage at their current jobs.

The analysis of part of the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

Lower-income adults with employer coverage are more likely than their higher-income peers to report negative outcomes due to problems using their insurance, a new KFF analysis shows.

Drawing on data from the KFF Survey of Consumer Experiences with Health Insurance, the analysis shows that similar shares of lower- and higher-income adults with employer coverage report having common problems with their insurance such as denied claims or prior authorization issues.

At the same time, those with lower incomes are more likely than their higher-income peers to say they suffered adverse consequences due to insurance problems. This includes experiencing a significant delay in getting needed care or being unable to get recommended medical treatment. In addition, nearly three times as many of those with lower incomes report suffering a moderate or serious decline in their health compared to those with higher incomes.

In addition, about three-in-10 people with employer coverage also say that they had problems paying for medical care in the past year (31%), more than double the share among those with higher incomes (13%).

The analysis also examines differences among lower- and higher-income adults with employer coverage in their satisfaction with their coverage and plan’s provider networks, and in the ease of signing up and comparing their coverage options.