On the eve of the ACA’s major coverage expansions, the nation’s system of health insurance has many gaps that currently leave millions of people without coverage. Many workers, particularly low-wage workers, do not have access to coverage or cannot afford their share of premiums. The recent economic recession has also led to the loss of jobs and employer-sponsored insurance. Historically, the options for the uninsured population were often limited to the individual market, which is often expensive and under which many are denied coverage. Medicaid and CHIP have provided coverage to many families, but pre-ACA eligibility levels are low for parents and few states provide coverage to adults without dependent children. The ACA fills in many of these gaps by expanding Medicaid to low-income adults and providing subsidized coverage to people with incomes below 400% of poverty in the state-based Marketplaces. However, many poor uninsured adults may be left without options in states that do not expand Medicaid. Even so, the ACA has the potential to provide coverage to those who need it, ensuring that fewer individuals and families will face the health and financial consequences of not having health insurance.

This Kaiser Commission on Medicaid and the Uninsured report was co-authored by Vann Newkirk, Rachel Licata, and Rachel Garfield of the Kaiser Family Foundation and Emily Lawton and Megan McGrath of the Urban Institute.

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