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The Uninsured: A Primer - Key Facts about Health Insurance and the Uninsured Under the Affordable Care Act


The Affordable Care Act (ACA) led to historic gains in health insurance coverage. The ACA builds on the foundation of employer-based coverage and fills gaps in insurance availability and affordability by expanding Medicaid for adults with incomes at or below 138% of the federal poverty level ($16,643 per year for an individual in 2017)1 and providing premium tax credits to make private insurance in the individual market more affordable for many with incomes between 100-400% of poverty (between $11,880 and $47,520 per year for an individual in 2016). Most of the ACA’s major coverage provisions went into effect in 2014, and millions of people have gained coverage under the law. Despite historic coverage gains, millions of people continue to lack coverage for a variety of reasons. For example, Medicaid eligibility for adults remains limited in states that have not adopted the expansion, some people remain ineligible for financial assistance for private coverage, and some still find coverage unaffordable even with financial assistance. Furthermore, recent efforts to alter the ACA or fundamentally change the structure of Medicaid may pose a challenge to further reducing the number of uninsured and may threaten coverage gains seen in recent years.

The gaps in our health insurance system affect people of all ages, races and ethnicities; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s ability to access needed medical care and their financial security. As a result, uninsured people are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact can also be severe. Uninsured families struggle financially to meet basic needs, and medical bills can quickly lead to medical debt.

The Uninsured: A Primer provides information on how insurance has changed under the ACA, how many people remain uninsured, who they are, and why they lack health coverage. It also summarizes what we know about the impact that a lack of insurance can have on health outcomes and personal finances and the difference health insurance can make in people’s lives.

Executive Summary How has health insurance coverage changed under the ACA?

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.