- Data on demographics; health coverage, access, and utilization; and health status by race and ethnicity provides insight into the status of health disparities and changes since implementation of the ACA.
- In 2021, 27.5 million nonelderly individuals were uninsured, a drop of nearly 1.5 million from 2019. We describe recent trends in health coverage, examine the characteristics of the uninsured, and summarize the access and financial implications of not having coverage.
- Nationally, 2.2 million poor uninsured adults were in the ACA “coverage gap” in 2019 in states that had not expanded Medicaid. They earned too much to be eligible for Medicaid but not enough to qualify for Marketplace premium tax credits. Three-quarters of them reside in just four states: Texas, Florida, Georgia and North Carolina.
- Twelve states have not adopted the ACA Medicaid expansion, leaving 2.2 million people in the coverage gap. Understanding the characteristics of this group can help inform policy decisions.
Implications of the Lapse in Federal COVID-19 Funding on Access to COVID-19 Testing, Treatment, and Vaccines
A current impasse in Congress threatens continued funding for COVID-19 testing, treatment, and vaccines. The lack of additional federal COVID-19 funding has broad implications for access to these services, particularly for the uninsured, and could undermine efforts to ensure equitable access to these resources.
Continuous enrollment in Medicaid and enhanced premium assistance have helped millions afford and maintain coverage, but those gains could be reversed as the public emergency ends and if the provisions like those in the Build Back Better Act fail to pass.
Medicaid Pandemic Enrollment Policies Helped Drive a Drop in the Uninsured Rate in 2021, but the Coverage Gains Are at RiskThe uninsured rate fell to 8.6% in 2021, matching a historic low. It was driven by a rise in public coverage during the pandemic, especially Medicaid. But the end of the public health emergency and the federal continuous enrollment requirement could put some of the coverage gains at risk.