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The Uninsured: A Primer - Key Facts about Health Insurance and the Uninsured in the Wake of National Health Reform

Executive Summary
  1. Robin A. Cohen, Michael E. Martinez, and Emily P. Zammitti, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2016 (National Center for Health Statistics, Sept 2016), https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf.

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  2. Kaiser Family Foundation analysis of the 2013 Kaiser Survey of Low-Income Americans and the ACA, 2014.

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  3. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS

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  4. Bianca DiJulio, Jamie Firth, and Mollyann Brodi,  Kaiser Health Tracking Poll: December 2015, (Washington, D.C.: Kaiser Family Foundation, Dec 2015),  http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-december-2015/.

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  5. Kaiser Family Foundation analysis of the 2014 Kaiser Survey of Low-Income Americans and the ACA, 2015.

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  6. Catherine Hoffman, Anthony Damico, and Rachel Garfield, Research Brief: Insurance Coverage and Access to Care in Primary Care Shortage Areas (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Feb 2011), http://kff.org/health-reform/issue-brief/research-brief-insurance-coverage-and-access-to/.

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Introduction
  1. “2015 Poverty Guidelines,” U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, accessed September 29, 2016, https://aspe.hhs.gov/2015-poverty-guidelines.

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How has health insurance coverage changed under the ACA?
  1.   Cohen, et al., Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2016 (National Center for Health Statistics, Sept 2016), https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf.

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  2. Ibid.

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  3. Ibid.

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  4. Kaiser Family Foundation analysis of the 2013 Kaiser Survey of Low-Income Americans and the ACA, 2014.

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  5. Kaiser Family Foundation and Health Research and Educational Trust, 2013 Employer Health Benefits Survey (Washington, DC: Kaiser Family Foundation, Aug 2013)https://www.kff.org/private-insurance/report/2013-employer-health-benefits/.

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  6. Larry Levitt, Gary Claxton, and Anthony Damico, Measuring the Affordability of Employer Health Coverage (Washington, DC: Kaiser Family Foundation, August 2011), https://www.kff.org/health-costs/perspective/measuring-the-affordability-of-employer-health-coverage/.

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  7. Kaiser Family Foundation and Health Research and Educational Trust, 2013 Employer Health Benefits Survey (Washington, DC: Kaiser Family Foundation, August 2013),  https://www.kff.org/private-insurance/report/2013-employer-health-benefits/.

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  8. Ibid.

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  9. John Holohan and Megan McGrath, Reversing the Trend? Understanding the Recent Increase in Health Insurance Coverage among the Nonelderly Population (Washington, DC: Kaiser Commission on Medicaid and the Uninsured and The Urban Institute, March 2013), http://kff.org/uninsured/issue-brief/reversing-the-trend-understanding-the-recent-increase-in-health-insurance-coverage-among-the-nonelderly-population/.

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  10. Laura Skopec, John Holahan, and Megan McGrath, Health Insurance Coverage in 2013: Gains in Public Coverage Continue to Offset Loss of Private Insurance (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2015), http://kff.org/uninsured/issue-brief/health-insurance-coverage-in-2013-gains-in-public-coverage-continue-to-offset-loss-of-private-insurance/.

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  11. Kaiser Family Foundation analysis of the 2014 ASEC Supplement to the CPS.

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  12. Kaiser Family Foundation State Health Facts. Data Source: The Census Bureau's March 2014 Current Population Survey (CPS: Annual Social and Economic Supplements), accessed October 8, 2015, http://kff.org/other/state-indicator/nonelderly-0-64/.

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  13. Medicaid also covers low-income elderly individuals, many of whom also have Medicare coverage. Molly O'Malley Watts, Elizabeth Cornachione, and MaryBeth Musumeci, Medicaid Financial Eligibility for Seniors and People with Disabilities in 2015 (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2016), http://kff.org/medicaid/report/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-in-2015/.

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  14. Marks C, Schwartz T, and Donaldson L, “State Variation and Health Reform: A Chartbook”, (Washington, DC: Kaiser Family Foundation, Oct 2009),  https://www.kff.org/health-reform/report/state-variation-and-health-reform-a-chartbook/.

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  15. Kaiser Family Foundation analysis of the 2014 ASEC Supplement to the CPS.

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  16. Kaiser Family Foundation State Health Facts, “Status of State Action on the Medicaid Expansion Decision,” accessed October 14, 2016, http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

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  17. Tricia Brooks, Sean Miskell, Samantha Artiga, Elizabeth Cornachione, and Alexandra Gates, Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2016  (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, Jan 2016), http://kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2016-findings-from-a-50-state-survey/.

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  18. Ibid.

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  19. Kaiser Family Foundation State Health Facts, “State Health Insurance Marketplace Types, 2016”, Data Source: Data compiled through review of state legislation and other Marketplace documents by the Kaiser Family Foundation, accessed September 29, 2016, http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/.

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  20. “2015 Poverty Guidelines,” U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, accessed September 29, 2016, https://aspe.hhs.gov/2015-poverty-guidelines.

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  21. Tax credit eligibility in a given calendar year is based on the previous year’s HHS poverty guidelines.

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  22. Kaiser Commission on Medicaid and the Uninsured, Key Facts on Health Coverage for Low-Income Immigrants Today and Under the Affordable Care Act (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2013), http://kff.org/disparities-policy/fact-sheet/key-facts-on-health-coverage-for-low/.

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  23. Ibid.

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  24. Centers for Medicare and Medicaid Services, Health Insurance Marketplace, Who Can Use the SHOP Marketplace, (Baltimore, MD: CMS, Health Insurance Marketplace, Oct 2014), https://marketplace.cms.gov/outreach-and-education/who-can-use-shop.pdf.

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  25. From 2010 through 2013, employers could receive a tax credit of up to 35% of the employer’s contribution to the premium, calculated on a sliding scale basis tied to average wages and number of employees. For small businesses with tax-exempt status meeting the requirements above, the tax credit is 25% of the employer contribution. In order to qualify, a business must have offered and contributed to at least 50% of employee-only coverage for each employee.

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  26. Kaiser Family Foundation, Explaining Health Reform: How will the Affordable Care Act affect Small Businesses and their Employees? (Washington, DC: Kaiser Family Foundation, Jan 2012), http://kff.org/health-reform/fact-sheet/explaining-health-reform-how-will-the-affordable-care-act-affect-small-businesses-and-their-employees/.

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  27. Laura Skopec, John Holahan, and Megan McGrath, Health Insurance Coverage in 2013: Gains in Public Coverage Continue to Offset Loss of Private Insurance (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2015), http://kff.org/uninsured/issue-brief/health-insurance-coverage-in-2013-gains-in-public-coverage-continue-to-offset-loss-of-private-insurance/.

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  28. Richard Cauchi, Small and Large Business Health Insurance: State and Federal Roles (Denver, CO: National Conference of State Legislatures, June 2016), (http://www.ncsl.org/research/health/small-business-health-insurance.aspx.

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  29.  Cohen, et al., Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2016 (National Center for Health Statistics, September 2016), https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf.

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  30. Ibid.

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  31. The Kaiser Family Foundation State Health Facts. Data Source: CMS, Medicaid & CHIP Monthly Applications, “Eligibility Determinations, and Enrollment Reports: February 2014 - August 2015 (preliminary), as of October 26, 2015”, accessed September 29, 2016, http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/.

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  32. CMS, “March 31, 2016 Effectuated Enrollment Snapshot”, (Baltimore, MD: CMS, March 2016),  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html.

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  33. Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion on the ACA: Findings From a Literature Review (Washington, DC: Kaiser Family Foundation, Jun 2016), http://kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-findings-from-a-literature-review/.

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  34. Kaiser Family Foundation and Health Research and Educational Trust, 2016 Employer Health Benefits Survey, (Washington, DC: Kaiser Family Foundation, Sept 2016),  http://kff.org/report-section/ehbs-2016-section-two-health-benefits-offer-rates/.

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  35. Kaiser Family Foundation and Health Research and Educational Trust, 2016 Employer Health Benefits Survey, (Washington, DC: Kaiser Family Foundation, Sept 2016), http://kff.org/report-section/ehbs-2016-section-three-employee-coverage-eligibility-and-participation/.

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  36.  Robin Rudowitz, Samantha Artiga, Anthony Damico, and Rachel Garfield, A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP (Washington DC: Kaiser Commission on Medicaid and the Uninsured, Feb 2016), http://kff.org/uninsured/issue-brief/a-closer-look-at-the-remaining-uninsured-population-eligible-for-medicaid-and-chip/.

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  37. Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels and 2015 CPS data.

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  38. Rachel Garfield and Anthony Damico, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update (Washington, DC: Kaiser Family Foundation, January 2016), http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/.

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  39. Ibid.

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Who remains uninsured after the ACA and why do they lack coverage?
  1. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS

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  2. Bianca DiJulio, Jamie Firth, and Mollyann Brodie,  Kaiser Health Tracking Poll: December 2015, (Washington, D.C.: Kaiser Family Foundation, Dec 2015),  http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-december-2015/ .

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  3. [iii] U.S. Census Bureau, Social, Economic, and Housing Statistics Division, “Poverty Thresholds”, http://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html.

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  4. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  5. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  6. See Supplemental Tables, Table 8.

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  7. Rachel Garfield and Katherine Young, Adults Who Remained Uninsured at the End of 2014 (Washington, DC: Kaiser Family Foundation, January 2015), http://kff.org/health-reform/issue-brief/adults-who-remained-uninsured-at-the-end-of-2014/.

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  8. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  9. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  10. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  11. Kaiser Family Foundation, State Health Facts. Data Source: Based on state-reported eligibility levels as of January 1, 2015, collected through a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families, accessed October 8, 2015, http://kff.org/health-reform/state-indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level/.

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  12. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  13. Other public programs include some state-funded programs for immigrants otherwise ineligible for Medicaid. Kaiser Family Foundation analysis based on 2016 Medicaid eligibility levels and 2016 Current Population Survey.

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  14. Benjamin Sommers, “Insuring Children or Insuring Families: Do Parental and Sibling Coverage Lead to Improved Retention of Children in Medicaid and CHIP?” Journal of Health Economics 25, no.6 (November 2006): 1154-69.

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  15. Jennifer Devoe, Courtney Crawford, Heather Angier, Jean O’malley, Charles Gallia et al. “The Association Between Medicaid Coverage for Children and Parents Persists: 2002-2010,” Maternal and Child Health Journal 19, no. 8 (August 2015): 1766-1774.

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  16. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  17. Kaiser Family Foundation analysis of the 2016 ASEC Supplement to the CPS.

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  18. Bianca DiJulio, Jamie Firth, and Mollyann Brodie, Kaiser Health Tracking Poll: December 2015 (Washington, DC: Kaiser Family Foundation, Dec 2015), http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-december-2015/.

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  19. Rachel Garfield, Anthony Damico, Cynthia Cox, Gary Claxton, and Larry Levitt, New Estimates of Eligibility for ACA Coverage among the Uninsured (Washington, DC:  Kaiser Family Foundation, Jan 2016), http://kff.org/health-reform/issue-brief/new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured/.

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  20. Kaiser Family Foundation, Few Uninsured Know Date of Pending Deadline for Obtaining Marketplace Coverage; Many Say They Will Get Coverage Soon, Though Cost is a Concern (Washington, D.C.: Kaiser Family Foundation, Dec 2015),  http://kff.org/health-costs/press-release/few-uninsured-know-date-of-pending-deadline-for-obtaining-marketplace-coverage-many-say-they-will-get-coverage-soon-though-cost-is-a-concern/.

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  21. Kaiser Family Foundation analysis of the 2015 National Health Interview Survey.

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How does lack of insurance affect access to health care?
  1. Kaiser Family Foundation analysis of the 2015 National Health Interview Survey

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  2. Kaiser Family Foundation analysis of the 2015 National Health Interview Survey.

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  3. Kaiser Family Foundation analysis of the 2015 National Health Interview Survey.

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  4. Jack Hadley, “Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition,” JAMA 297, no. 10 (March 2007): 1073-84.

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  5. Broadwater-Hollifield et al. “Predictors of Patient Adherence to Follow-Up Recommendations after an ED Visit,” The American Journal of Emergency Medicine 33, no.10 (October 2015): 1368-73.

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  6. Silvia Tejada et al., “Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities.” Journal of Women's Health 22, no. 6 (June 2013): 507-517.

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  7. Andrew Wilper et al., “Health Insurance and Mortality in US Adults,” American Journal of Public Health 99, no. 12 (December 2009): 2289-2295.

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  8. Edgar Simard et al., “Widening Socioeconomic Disparities in Cervical Cancer Mortality Among Women in 26 States, 1993-2007.” Cancer 118, no. 20 (October 2012): 5110-6.

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  9. Institute of Medicine, America’s Uninsured Crisis: Consequences for Health and Health Care (Washington, DC: Institute of Medicine, February 2009), http://iom.nationalacademies.org/~/media/Files/Report%20Files/2009/Americas-Uninsured-Crisis-Consequences-for-Health-and-Health-Care/Americas%20Uninsured%20Crisis%202009%20Report%20Brief.pdf.

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  10. [x]  Fizan Abdullah et al., “Analysis of 23 Million US Hospitalizations: Uninsured Children Have Higher All-Cause In-Hospital Mortality,” Journal of Public Health 32, no. 2 (June 2010): 236-44.

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  11.   Andrew Wilper et al., “Health Insurance and Mortality in US Adults,” American Journal of Public Health 99, no. 12 (December 2009): 2289-2295.

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  12. Wendy Greene et al., “Insurance Status is a Potent Predictor of Outcomes in Both Blunt and Penetrating Trauma.” American Journal of Surgery 199, no. 4 (April 2010): 554-7.

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  13. Sarah Lyon, “The Effect of Insurance Status on Mortality and Procedural Use in Critically Ill Patients,” American Journal of Critical Care Medicine 184, no. 7 (October 2011): 809-15.

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  14. Kaiser Family Foundation analysis of 2015 NHIS data.

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  15. Institute of Medicine, America’s Uninsured Crisis: Consequences for Health and Health Care (Washington, DC: Institute of Medicine, February 2009), http://iom.nationalacademies.org/~/media/Files/Report%20Files/2009/Americas-Uninsured-Crisis-Consequences-for-Health-and-Health-Care/Americas%20Uninsured%20Crisis%202009%20Report%20Brief.pdf.

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  16. Amanda Haboush-Deloye, Spencer Hensley, Masaru Teramoto, Tara Phebus, Denise Tanata-Ashby, “The Impacts of Health Insurance Coverage on Access to Healthcare in Children Entering Kindergarten,” Maternal and Child Health Journal 18, no.7 (Sep 2014): 1753-64.

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  17. Institute of Medicine, America’s Uninsured Crisis: Consequences for Health and Health Care (Washington, DC: Institute of Medicine, February 2009), http://iom.nationalacademies.org/~/media/Files/Report%20Files/2009/Americas-Uninsured-Crisis-Consequences-for-Health-and-Health-Care/Americas%20Uninsured%20Crisis%202009%20Report%20Brief.pdf.

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  18. Sara Collins et al., Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help (The Commonwealth Fund, April 2012), http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Apr/1594_collins_gaps_in_hlt_ins_tracking_brief_v2.pdf.

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  19. Amy Cassedy, Gerry Fairbrother, and Paul Newacheck, “The Impact of Insurance Instability on Children’s Access, Utilization, and Satisfaction with Health Care,” Ambulatory Pediatrics 8, no. 5 (October 2008): 321-8.

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  20. Thomas Buchmueller, Sean Orzol, and Lara Shore-Sheppard, “Stability of Children’s Insurance Coverage and Implications for Access to Care: Evidence from the Survey of Income and Program Participation”, International Journal of Health Care Finance and Economics 14, no.2 (Jun 2014).

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  21. Salam Abdus, “Part-Year Coverage and Access to Care for Nonelderly Adults,” Medical Care 52, no. 8 (August 2014): 709-14.

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  22. Amy Finkelstein et al., “The Oregon Health Insurance Experiment: Evidence from the First Year” (National Bureau of Economic Research, July 2011), http://www.nber.org/papers/w17190.

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  23. Katherine Baicker et al., “The Oregon Experiment — Effects of Medicaid on Clinical Outcomes,” New England Journal of Medicine 368 (May 2013): 1713-1722.

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  24. Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion on the ACA: Findings From a Literature Review (Washington, D.C.: Kaiser Family Foundation, Jun 2016),  http://kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-findings-from-a-literature-review/.

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  25. James B Kirby and Jessica P. Vistnes,“Access to Care Improved for People Who Gained Medicaid or Marketplace Coverage in 2014” Health Affairs,35, no.10 (Oct 2016): 1830-1834.

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  26. Mark Hall, “Rethinking Safety Net Access for the Uninsured,” New England Journal of Medicine 364 (January 2011):7-9.

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  27. John Holahan and Brenda Spillman, Health Care Access for Uninsured Adults: A Strong Safety Net is not the Same as Insurance (Washington, DC: The Urban Institute, January 2002), http://www.urban.org/research/publication/health-care-access-uninsured-adults.

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  28. Peter Shin et al., Health Center Patient Trends, Enrollment Activities, and Service Capacity: Recent Experience in Medicaid Expansion and Non-Expansion States, (Washington, DC: Kaiser Commission for Medicaid and the Uninsured, Dec 2015), http://kff.org/medicaid/issue-brief/health-center-patient-trends-enrollment-activities-and-service-capacity-recent-experience-in-medicaid-expansion-and-non-expansion-states.

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  29. Sara Rosenbaum and Julia Paradise. Community Health Centers: Growth and Challenges under Health Reform, (Washington, DC: Kaiser Commission for Medicaid and the Uninsured, forthcoming).

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  30. Ibid.

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What are the financial implications of lacking coverage?
  1. Kaiser Family Foundation analysis of the 2014 Kaiser Survey of Low-Income Americans and the ACA, 2015.

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  2. Gerard Anderson , “From ‘Soak The Rich’ To ‘Soak The Poor’: Recent Trends In Hospital Pricing” Health Affairs 26, no. 4  (May 2007): 780-789.

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  3. Stacie Dusetzina, Ethan Basch, and Nancy Keating, “For Uninsured Cancer Patients, Outpatient Charges Can Be Costly, Putting Treatments out of Reach,” Health Affairs 34, no. 4 (April 2015): 584-591.

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  4. Kaiser Family Foundation analysis of the 2014 Kaiser Survey of Low-Income Americans and the ACA, 2015.

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  5. [v] Brent Asplin et al., “Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments,” JAMA 294, no. 10 (September 2005): 1248-54.

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  6. Kaiser Family Foundation analysis of the 2013 Kaiser Survey of Low-Income Americans and the ACA, 2014.

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  7. Teresa Coughlin et al., Uncompensated Care for the Uninsured in 2013: A Detailed Examination (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, May 2014), http://kff.org/uninsured/report/uncompensated-care-for-the-uninsured-in-2013-a-detailed-examination/.

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  8. Ibid.

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  9. Ibid.

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  10. Ibid.

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  11. Peter Cunningham, Robin Rudowitz, Katherine Young, Rachel Garfield, and Julia Foutz, Understanding Medicaid Hospital Payment and the Impact of Recent Policy Changes, (Washington, DC: Kaiser Family Foundation, June 2016), http://kff.org/medicaid/issue-brief/understanding-medicaid-hospital-payments-and-the-impact-of-recent-policy-changes/.

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  12.  [xii] H.R. Medicare Access and CHIP Reauthorization Act of 2015, H.R. 2, 114th Cong. (2015).

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  13. Kaiser Family Foundation State Health Facts, “Federal Medicaid Disproportionate Share Hospital (DSH) Allotments, FY 2015”, Data Source: GPO Federal Register 81, no.21, http://kff.org/medicaid/state-indicator/federal-dsh-allotments/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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  14. H.R. Medicare Access and CHIP Reauthorization Act of 2015, H.R. 2, 114th Cong. (2015).

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  15. 42 U.S.C. § 1396r-4(f)(7)(A)(ii)(VI), (VII), http://www.law.cornell.edu/uscode/text/42/1396r.

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  16. HHS, Office of the Assistant Secretary for Planning and Evaluation, The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills (HHS, ASPE, May 2011), https://aspe.hhs.gov/basic-report/value-health-insurance-few-uninsured-have-adequate-resources-pay-potential-hospital-bills.

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  17. Ibid.

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  18.  [xviii] Sherry Glied and Richard Kronick, The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills (Washington, DC: Office of Assistant Secretary for Planning and Evaluation, HHS, May 2011), http://aspe.hhs.gov/health/reports/2011/ValueofInsurance/rb.pdf.

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  19. Kaiser Family Foundation analysis of the 2015 National Health Interview Survey.

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  20. Kaiser Family Foundation analysis of Kaiser Family Foundation/New York Times Medical Bills Survey, Jan 2016.

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  21. Consumer Financial Protection Bureau, Consumer Credit Reports: A Study of Medical and Non-Medical Collections (consumer Financial Protection Bureau, December 2014), http://files.consumerfinance.gov/f/201412_cfpb_reports_consumer-credit-medical-and-non-medical-collections.pdf.

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  22. David Himmelstein et al., “Medical bankruptcy in the United States, 2007: results of a national study,” The American Journal of Medicine 122, no. 8 (August 2009): 741-6, http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf.

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Conclusion
  1. Catherine Hoffman, Anthony Damico, and Rachel Garfield, Research Brief: Insurance Coverage and Access to Care in Primary Care Shortage Areas (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, February 2011), http://kff.org/health-reform/issue-brief/research-brief-insurance-coverage-and-access-to/.

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